Provider Demographics
NPI:1598940512
Name:REACH CHIROPRACTIC LIFE CENTER PC
Entity Type:Organization
Organization Name:REACH CHIROPRACTIC LIFE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:REACH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:602-867-4210
Mailing Address - Street 1:12802 N CAVE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-5825
Mailing Address - Country:US
Mailing Address - Phone:602-867-4210
Mailing Address - Fax:602-867-7600
Practice Address - Street 1:12802 N CAVE CREEK RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-5825
Practice Address - Country:US
Practice Address - Phone:602-867-4210
Practice Address - Fax:602-867-7600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4534111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0234000OtherBLUE CROSS BLUE SHIELD
AZ35WCHLL06Medicare PIN
AZ28070189Medicare UPIN