Provider Demographics
NPI:1801023015
Name:WAXMAN CHIROPRACTIC SERVICES P.C.
Entity Type:Organization
Organization Name:WAXMAN CHIROPRACTIC SERVICES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:WAXMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:602-253-8823
Mailing Address - Street 1:809 E WASHINGTON ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85034-1052
Mailing Address - Country:US
Mailing Address - Phone:602-253-8823
Mailing Address - Fax:602-253-0457
Practice Address - Street 1:809 E WASHINGTON ST
Practice Address - Street 2:SUITE 204
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-1052
Practice Address - Country:US
Practice Address - Phone:602-253-8823
Practice Address - Fax:602-253-0457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3220111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ186380126Medicare PIN