Provider Demographics
NPI:1831134550
Name:BLUE STREAK INVESTMENTS LLC
Entity Type:Organization
Organization Name:BLUE STREAK INVESTMENTS LLC
Other - Org Name:BACK USA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-396-2225
Mailing Address - Street 1:4121 E VALLEY AUTO DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4631
Mailing Address - Country:US
Mailing Address - Phone:480-396-2225
Mailing Address - Fax:480-396-1099
Practice Address - Street 1:4121 E VALLEY AUTO DR
Practice Address - Street 2:SUITE 110
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4631
Practice Address - Country:US
Practice Address - Phone:480-396-2225
Practice Address - Fax:480-396-1099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty