Provider Demographics
NPI:1609037068
Name:INTEGRATED REHAB OF AZ INC
Entity Type:Organization
Organization Name:INTEGRATED REHAB OF AZ INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALAVIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:602-923-6666
Mailing Address - Street 1:4045 E BELL RD STE 105
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2237
Mailing Address - Country:US
Mailing Address - Phone:602-923-6666
Mailing Address - Fax:
Practice Address - Street 1:4045 E BELL RD STE 105
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2237
Practice Address - Country:US
Practice Address - Phone:602-923-6666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7119111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty