Provider Demographics
NPI:1629406467
Name:ARIZONA CHIROPRACTIC GROUP
Entity Type:Organization
Organization Name:ARIZONA CHIROPRACTIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:ENSIGN
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-883-2266
Mailing Address - Street 1:12220 E RIGGS RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-3738
Mailing Address - Country:US
Mailing Address - Phone:480-883-2266
Mailing Address - Fax:480-883-2289
Practice Address - Street 1:12220 E RIGGS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-3738
Practice Address - Country:US
Practice Address - Phone:480-883-2266
Practice Address - Fax:480-883-2289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-14
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8346111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty