Provider Demographics
NPI:1841430667
Name:SOUTHWEST CHIROPRACTIC GROUP PLLC
Entity Type:Organization
Organization Name:SOUTHWEST CHIROPRACTIC GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRAEME
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:602-992-4770
Mailing Address - Street 1:20701 N SCOTTSDALE RD
Mailing Address - Street 2:#107-200
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-6413
Mailing Address - Country:US
Mailing Address - Phone:602-992-4770
Mailing Address - Fax:
Practice Address - Street 1:4845 E THUNDERBIRD RD
Practice Address - Street 2:#4
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-3556
Practice Address - Country:US
Practice Address - Phone:602-992-4770
Practice Address - Fax:602-992-4053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7083111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1013050491OtherPHYSICIAN NPI