Provider Demographics
NPI:1992036446
Name:CACTUS FLOWER CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:CACTUS FLOWER CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:SHOCHAT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:520-293-3751
Mailing Address - Street 1:5813 N. ORACLE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-3813
Mailing Address - Country:US
Mailing Address - Phone:520-293-3751
Mailing Address - Fax:520-293-8666
Practice Address - Street 1:5813 N. ORACLE ROAD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-3813
Practice Address - Country:US
Practice Address - Phone:520-293-3751
Practice Address - Fax:520-293-8666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-22
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3123111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0935370OtherBLUE CROSS BLUE SHIELD
AZAZ0935370OtherBLUE CROSS BLUE SHIELD