Provider Demographics
NPI:1922160910
Name:PANCHESIN CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:PANCHESIN CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PANCHESIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:520-294-0400
Mailing Address - Street 1:5311 S 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85706-3201
Mailing Address - Country:US
Mailing Address - Phone:520-294-0400
Mailing Address - Fax:520-741-8158
Practice Address - Street 1:5311 S 12TH AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85706-3201
Practice Address - Country:US
Practice Address - Phone:520-294-0400
Practice Address - Fax:520-741-8158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3682111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0945050OtherBCBS
AZZ140300Medicare PIN