Provider Demographics
NPI:1790810067
Name:BRENAJ CHIROPRACTIC GROUP LLC
Entity Type:Organization
Organization Name:BRENAJ CHIROPRACTIC GROUP LLC
Other - Org Name:PEBBLECREEK CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ADEYEMO
Authorized Official - Last Name:IJIWOYE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:623-535-7500
Mailing Address - Street 1:325 N. ALMA SCHOOL ROAD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-4379
Mailing Address - Country:US
Mailing Address - Phone:480-912-3003
Mailing Address - Fax:480-264-3048
Practice Address - Street 1:325 N ALMA SCHOOL RD STE 1
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-4379
Practice Address - Country:US
Practice Address - Phone:480-912-3003
Practice Address - Fax:480-264-3048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8521111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0155870OtherBLUECROSS BLUSHEILD AZ