Provider Demographics
NPI:1649414608
Name:CHIROPRACTIC INJURY OF ARIZONA
Entity Type:Organization
Organization Name:CHIROPRACTIC INJURY OF ARIZONA
Other - Org Name:INJURY CARE OF ARIZONA
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-278-1569
Mailing Address - Street 1:PO BOX 27605
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85285-7605
Mailing Address - Country:US
Mailing Address - Phone:480-278-1569
Mailing Address - Fax:480-699-4607
Practice Address - Street 1:1324 W PRINCE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-3115
Practice Address - Country:US
Practice Address - Phone:480-278-1569
Practice Address - Fax:480-699-4607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-21
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4420111N00000X, 111NR0400X
AZ975111N00000X
AZ6028111N00000X
AZ4560111N00000X
AZ7385111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty