Provider Demographics
NPI:1598961724
Name:KEARNY CHIROPRACTIC, LTD.
Entity Type:Organization
Organization Name:KEARNY CHIROPRACTIC, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRET
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:623-556-2335
Mailing Address - Street 1:16846 W. BELL ROAD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SURPIRSE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374
Mailing Address - Country:US
Mailing Address - Phone:623-556-2335
Mailing Address - Fax:623-556-9382
Practice Address - Street 1:16846 W. BELL ROAD
Practice Address - Street 2:SUITE 112
Practice Address - City:SURPIRSE
Practice Address - State:AZ
Practice Address - Zip Code:85374
Practice Address - Country:US
Practice Address - Phone:623-556-2335
Practice Address - Fax:623-556-9382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4307111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z74358Medicare PIN