Provider Demographics
NPI:1932319175
Name:PORTER CHIROPRACTIC CENTER LLC.
Entity Type:Organization
Organization Name:PORTER CHIROPRACTIC CENTER LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:623-882-2121
Mailing Address - Street 1:919 N DYSART RD STE C
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-1711
Mailing Address - Country:US
Mailing Address - Phone:623-882-2121
Mailing Address - Fax:623-882-2123
Practice Address - Street 1:919 N DYSART RD STE C
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-1711
Practice Address - Country:US
Practice Address - Phone:623-882-2121
Practice Address - Fax:623-882-2123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7252111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ74816Medicare ID - Type Unspecified