Provider Demographics
NPI:1619399714
Name:CD HEALTHCARE,LLC
Entity Type:Organization
Organization Name:CD HEALTHCARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:DEFRIES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-272-8944
Mailing Address - Street 1:4540 E BASELINE RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4613
Mailing Address - Country:US
Mailing Address - Phone:480-272-8944
Mailing Address - Fax:480-237-5682
Practice Address - Street 1:4540 E BASELINE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4613
Practice Address - Country:US
Practice Address - Phone:480-272-8944
Practice Address - Fax:480-237-5682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-09
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty