Provider Demographics
NPI:1669664900
Name:SOUTH MOUNTAIN CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:SOUTH MOUNTAIN CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTYN
Authorized Official - Middle Name:ELIZEBETH
Authorized Official - Last Name:EMPIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-759-8566
Mailing Address - Street 1:5505 W CHANDLER BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-3683
Mailing Address - Country:US
Mailing Address - Phone:480-759-8566
Mailing Address - Fax:480-704-2448
Practice Address - Street 1:5505 W CHANDLER BLVD STE 3
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-3683
Practice Address - Country:US
Practice Address - Phone:480-759-8566
Practice Address - Fax:480-704-2448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ102077Medicare PIN