Provider Demographics
NPI:1578721056
Name:MERCY RD.CHIROPRACTIC,P.L.L.C.
Entity Type:Organization
Organization Name:MERCY RD.CHIROPRACTIC,P.L.L.C.
Other - Org Name:JUDGE CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:DIETMAR
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-735-1034
Mailing Address - Street 1:288 N IRONWOOD DR STE 108
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85120-3830
Mailing Address - Country:US
Mailing Address - Phone:480-983-1274
Mailing Address - Fax:480-983-1275
Practice Address - Street 1:288 N IRONWOOD DR
Practice Address - Street 2:#108-109
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85120-3830
Practice Address - Country:US
Practice Address - Phone:480-735-1034
Practice Address - Fax:480-983-1275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7864261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center