Provider Demographics
NPI:1578702437
Name:SPA CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:SPA CHIROPRACTIC PLLC
Other - Org Name:ACCIDENT CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:KOOP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:602-268-6000
Mailing Address - Street 1:6851 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-5420
Mailing Address - Country:US
Mailing Address - Phone:602-268-6000
Mailing Address - Fax:602-276-2600
Practice Address - Street 1:6851 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-5420
Practice Address - Country:US
Practice Address - Phone:602-268-6000
Practice Address - Fax:602-276-2600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-16
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6077111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty