Provider Demographics
NPI:1578299491
Name:SIERRA VISTA CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:SIERRA VISTA CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:GARET
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:520-459-1414
Mailing Address - Street 1:247 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2535
Mailing Address - Country:US
Mailing Address - Phone:520-459-1414
Mailing Address - Fax:520-459-2077
Practice Address - Street 1:247 S 7TH ST
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2535
Practice Address - Country:US
Practice Address - Phone:520-459-1414
Practice Address - Fax:520-459-2077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-25
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty