Provider Demographics
NPI:1619134327
Name:ARIZONA LIFE CHIROPRACTIC CENTER, LLC
Entity Type:Organization
Organization Name:ARIZONA LIFE CHIROPRACTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CATHCART
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:602-242-7537
Mailing Address - Street 1:2801 W NORTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-6646
Mailing Address - Country:US
Mailing Address - Phone:602-242-7537
Mailing Address - Fax:
Practice Address - Street 1:2801 W NORTHERN AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-6646
Practice Address - Country:US
Practice Address - Phone:602-242-7537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4994111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAX2979OtherHEALTH NET
AZAZ0293440OtherBLUECROSS BLUE SHIELD OF AZ
AZZ21759Medicare PIN