Provider Demographics
NPI:1710164355
Name:WEST VALLEY WELLNESS AND REHABILITATION PLLC
Entity Type:Organization
Organization Name:WEST VALLEY WELLNESS AND REHABILITATION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:CURTIS
Authorized Official - Last Name:NIELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:623-772-1444
Mailing Address - Street 1:9150 W INDIAN SCHOOL RD
Mailing Address - Street 2:STE 138
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-1904
Mailing Address - Country:US
Mailing Address - Phone:623-772-1444
Mailing Address - Fax:623-772-1333
Practice Address - Street 1:9150 W INDIAN SCHOOL RD
Practice Address - Street 2:STE 138
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-2384
Practice Address - Country:US
Practice Address - Phone:623-772-1444
Practice Address - Fax:623-772-1333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-25
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7303111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ107204Medicare PIN
AZU98752Medicare UPIN
AZZ107299Medicare PIN
AZU94863Medicare UPIN