Provider Demographics
NPI:1760237325
Name:AZ CHIROPRACTIC AND PHYSICAL MEDICINE LLC
Entity Type:Organization
Organization Name:AZ CHIROPRACTIC AND PHYSICAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:HIRST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-899-9923
Mailing Address - Street 1:3570 S VAL VISTA DR STE 110
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-7327
Mailing Address - Country:US
Mailing Address - Phone:480-899-9923
Mailing Address - Fax:
Practice Address - Street 1:3570 S VAL VISTA DR STE 110
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-7327
Practice Address - Country:US
Practice Address - Phone:480-899-9923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty