Provider Demographics
NPI:1952473514
Name:ARIZONA CHIROPRACTIC ORTHOPEDICS
Entity Type:Organization
Organization Name:ARIZONA CHIROPRACTIC ORTHOPEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:WESSELINK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:520-888-2600
Mailing Address - Street 1:4558 N 1ST AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5666
Mailing Address - Country:US
Mailing Address - Phone:520-888-2600
Mailing Address - Fax:520-888-3882
Practice Address - Street 1:4558 N 1ST AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-5666
Practice Address - Country:US
Practice Address - Phone:520-888-2600
Practice Address - Fax:520-888-3882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4388111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ79994Medicare ID - Type Unspecified
AZT01076Medicare UPIN