Provider Demographics
NPI:1972841252
Name:LLACA CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:LLACA CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:LLACA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-652-4788
Mailing Address - Street 1:7555 E OSBORN RD
Mailing Address - Street 2:STE 102
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6434
Mailing Address - Country:US
Mailing Address - Phone:480-652-4788
Mailing Address - Fax:480-945-7805
Practice Address - Street 1:7555 E OSBORN RD
Practice Address - Street 2:STE 102
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6434
Practice Address - Country:US
Practice Address - Phone:480-652-4788
Practice Address - Fax:480-945-7805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-22
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8126305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD07313168OtherDRIVERS LICENSE