Provider Demographics
NPI:1922066976
Name:HEAD 2 TOE CHIROPRACTIC AND HEALTHCARE CENTER PLLC
Entity Type:Organization
Organization Name:HEAD 2 TOE CHIROPRACTIC AND HEALTHCARE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PROVIDER, ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:602-908-3815
Mailing Address - Street 1:333 N DOBSON RD # 5-131
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-4412
Mailing Address - Country:US
Mailing Address - Phone:602-908-3815
Mailing Address - Fax:480-630-1859
Practice Address - Street 1:333 N DOBSON RD # 5-131
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-4412
Practice Address - Country:US
Practice Address - Phone:602-908-3815
Practice Address - Fax:480-630-1859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5741111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ502333Medicaid
AZZ60551Medicare ID - Type UnspecifiedMEDICARE
Z110068Medicare PIN