Provider Demographics
NPI:1588610208
Name:PREFERRED CHIROPRACTIC ONE, PC
Entity Type:Organization
Organization Name:PREFERRED CHIROPRACTIC ONE, PC
Other - Org Name:PREFERRED CHIROPRATIC CENTRES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-893-8600
Mailing Address - Street 1:5024 S ASH AVE
Mailing Address - Street 2:STE. 106
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-6847
Mailing Address - Country:US
Mailing Address - Phone:480-893-8600
Mailing Address - Fax:480-756-0229
Practice Address - Street 1:1855 E GUADALUPE RD
Practice Address - Street 2:STE. 112
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3273
Practice Address - Country:US
Practice Address - Phone:480-839-8552
Practice Address - Fax:480-752-7978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ68588Medicare ID - Type UnspecifiedGROUP NUMBER