Provider Demographics
NPI:1689881559
Name:DEMITH CHIROPRACTIC & ACUPUNCTURE HEALING CENTER L.L.C.
Entity Type:Organization
Organization Name:DEMITH CHIROPRACTIC & ACUPUNCTURE HEALING CENTER L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEMITH-OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:520-885-7944
Mailing Address - Street 1:7831 E WRIGHTSTOWN RD STE 103
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-4345
Mailing Address - Country:US
Mailing Address - Phone:520-885-7944
Mailing Address - Fax:520-885-8350
Practice Address - Street 1:7831 E WRIGHTSTOWN RD STE 103
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-4345
Practice Address - Country:US
Practice Address - Phone:520-885-7944
Practice Address - Fax:520-885-8350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5548111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU62605Medicare UPIN