Provider Demographics
NPI:1760735146
Name:ASHLEY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:ASHLEY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:N
Authorized Official - Last Name:WAGGONER-JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-259-0064
Mailing Address - Street 1:10153 E HAMPTON AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-3326
Mailing Address - Country:US
Mailing Address - Phone:480-254-4069
Mailing Address - Fax:480-535-5689
Practice Address - Street 1:10153 E HAMPTON AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-3326
Practice Address - Country:US
Practice Address - Phone:480-254-4069
Practice Address - Fax:480-535-5689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-22
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8036111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty