Provider Demographics
NPI:1639491418
Name:CHIROPRACTIC WELLNESS AND ALTERNATIVE MEDICINE CENTER INC.
Entity Type:Organization
Organization Name:CHIROPRACTIC WELLNESS AND ALTERNATIVE MEDICINE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:520-378-2777
Mailing Address - Street 1:4527 S HIGHWAY 92
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85650-9624
Mailing Address - Country:US
Mailing Address - Phone:520-378-2777
Mailing Address - Fax:520-378-2780
Practice Address - Street 1:4527 S HIGHWAY 92
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85650-9624
Practice Address - Country:US
Practice Address - Phone:520-378-2777
Practice Address - Fax:520-378-2780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ864111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ64244Medicare PIN
AZT41880Medicare UPIN