Provider Demographics
NPI:1881815504
Name:CASALINO CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:CASALINO CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:CASALINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:602-993-9933
Mailing Address - Street 1:10255 N 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-1361
Mailing Address - Country:US
Mailing Address - Phone:602-993-9933
Mailing Address - Fax:602-942-5032
Practice Address - Street 1:10255 N 35TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-1361
Practice Address - Country:US
Practice Address - Phone:602-993-9933
Practice Address - Fax:602-942-5032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4317111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ=========Medicare UPIN