Provider Demographics
NPI:1659425395
Name:CAS CHIROPRACTIC & REHABILITATON CENTER
Entity Type:Organization
Organization Name:CAS CHIROPRACTIC & REHABILITATON CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MOFFETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:623-849-9416
Mailing Address - Street 1:2330 N 75TH AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85035-1200
Mailing Address - Country:US
Mailing Address - Phone:623-849-9416
Mailing Address - Fax:623-849-9622
Practice Address - Street 1:4619 N 24TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-5203
Practice Address - Country:US
Practice Address - Phone:602-956-0111
Practice Address - Fax:602-956-6789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7068111N00000X
AZ3744225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ74775Medicare PIN