Provider Demographics
NPI:1700024742
Name:CENTER FOR ORTHOPEDIC RESEARCH AND EDUCATION
Entity Type:Organization
Organization Name:CENTER FOR ORTHOPEDIC RESEARCH AND EDUCATION
Other - Org Name:THE CORE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOFSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-537-5600
Mailing Address - Street 1:18444 N 25TH AVE
Mailing Address - Street 2:STE 310
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-1261
Mailing Address - Country:US
Mailing Address - Phone:623-537-5600
Mailing Address - Fax:866-936-2673
Practice Address - Street 1:3420 S MERCY RD
Practice Address - Street 2:STE 200
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-0419
Practice Address - Country:US
Practice Address - Phone:623-537-5600
Practice Address - Fax:866-939-2673
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR ORTHOPEDIC RESEARCH AND EDUCATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-29
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ341246Medicaid
AZZ102176Medicare PIN