Provider Demographics
NPI:1821131350
Name:FIRST HEALTH SYSTEMS LLC
Entity Type:Organization
Organization Name:FIRST HEALTH SYSTEMS LLC
Other - Org Name:JEFFREY MALLORY DC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR GEN MNG
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:GRANT
Authorized Official - Last Name:MALLORY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-962-0710
Mailing Address - Street 1:531 E UNIVERSITY DRIVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203
Mailing Address - Country:US
Mailing Address - Phone:480-962-0710
Mailing Address - Fax:480-962-0352
Practice Address - Street 1:531 E UNIVERSITY DRIVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203
Practice Address - Country:US
Practice Address - Phone:480-962-0710
Practice Address - Fax:480-962-0352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ02079111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
545180257Medicare ID - Type Unspecified