Provider Demographics
NPI:1790134724
Name:HEALTHY BEGINNINGS FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:HEALTHY BEGINNINGS FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:NICHOLE
Authorized Official - Last Name:CLOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-310-1792
Mailing Address - Street 1:3233 E RIDGEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-4305
Mailing Address - Country:US
Mailing Address - Phone:480-310-1792
Mailing Address - Fax:
Practice Address - Street 1:3303 S LINDSAY RD
Practice Address - Street 2:SUITE 125
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-1503
Practice Address - Country:US
Practice Address - Phone:480-310-1792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ8400OtherLICENSE