Provider Demographics
NPI:1659694156
Name:ASPEN RAE LLC
Entity Type:Organization
Organization Name:ASPEN RAE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:ASPEN
Authorized Official - Last Name:MCCALL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:623-572-9200
Mailing Address - Street 1:21681 N 77TH AVE
Mailing Address - Street 2:SUITE 1415
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-2132
Mailing Address - Country:US
Mailing Address - Phone:623-572-9200
Mailing Address - Fax:623-572-9204
Practice Address - Street 1:21681 N 77TH AVE
Practice Address - Street 2:SUITE 1415
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2132
Practice Address - Country:US
Practice Address - Phone:623-572-9200
Practice Address - Fax:623-572-9204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-11
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7250111NR0400X
AZ2747207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent MedicineGroup - Single Specialty