Provider Demographics
NPI:1598203192
Name:HEALTHY SPINES CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:HEALTHY SPINES CHIROPRACTIC, INC
Other - Org Name:HEALTHY SPINES CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:DC, FIAMA
Authorized Official - Phone:623-925-1386
Mailing Address - Street 1:1473 N DYSART RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-1548
Mailing Address - Country:US
Mailing Address - Phone:623-925-1386
Mailing Address - Fax:
Practice Address - Street 1:1473 N DYSART RD
Practice Address - Street 2:SUITE 101
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-1548
Practice Address - Country:US
Practice Address - Phone:623-925-1386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21055613305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service