Provider Demographics
NPI:1891085791
Name:HEATH CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:HEATH CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:HEATH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:602-249-6097
Mailing Address - Street 1:2423 W DUNLAP AVE
Mailing Address - Street 2:#170
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-2830
Mailing Address - Country:US
Mailing Address - Phone:602-249-6097
Mailing Address - Fax:602-995-3956
Practice Address - Street 1:2423 W DUNLAP AVE
Practice Address - Street 2:#170
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-2830
Practice Address - Country:US
Practice Address - Phone:602-249-6097
Practice Address - Fax:602-995-3956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ769111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty