Provider Demographics
NPI:1891799516
Name:PALISADES FAMILY CHIROPRACTIC WELLNESS CENTER INC
Entity Type:Organization
Organization Name:PALISADES FAMILY CHIROPRACTIC WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MONTEZ-WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-837-4444
Mailing Address - Street 1:16930 E PALISADES BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-4006
Mailing Address - Country:US
Mailing Address - Phone:480-837-4444
Mailing Address - Fax:480-837-4874
Practice Address - Street 1:16930 E PALISADES BLVD STE 104
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-4006
Practice Address - Country:US
Practice Address - Phone:480-837-4444
Practice Address - Fax:480-837-4874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5223111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ71314OtherMEDICARE ID - GROUP
AZAZ0936000OtherBLUE CROSS BLUE SHIELD #
AZAZ0936000OtherBLUE CROSS BLUE SHIELD #