Provider Demographics
NPI:1962660639
Name:POWER UP FAMILY CHIROPRACTIC, P.L.L.C.
Entity Type:Organization
Organization Name:POWER UP FAMILY CHIROPRACTIC, P.L.L.C.
Other - Org Name:POWER UP FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONTRERAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:602-569-9637
Mailing Address - Street 1:PO BOX 71505
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-1009
Mailing Address - Country:US
Mailing Address - Phone:602-569-9637
Mailing Address - Fax:602-569-9638
Practice Address - Street 1:21043 N CAVE CREEK RD
Practice Address - Street 2:#A5
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-5512
Practice Address - Country:US
Practice Address - Phone:602-569-9637
Practice Address - Fax:602-569-9638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ71909111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty