Provider Demographics
NPI:1871844910
Name:SCOTTSDALE CHIROPRACTIC LIFE CENTER PC
Entity Type:Organization
Organization Name:SCOTTSDALE CHIROPRACTIC LIFE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROSENBLUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-946-4532
Mailing Address - Street 1:8075 E MORGAN TRL
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-1293
Mailing Address - Country:US
Mailing Address - Phone:480-946-4532
Mailing Address - Fax:480-292-7301
Practice Address - Street 1:8075 E MORGAN TRL
Practice Address - Street 2:SUITE 2
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-1293
Practice Address - Country:US
Practice Address - Phone:480-946-4532
Practice Address - Fax:480-292-7301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4061111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty