Provider Demographics
NPI:1134800279
Name:100 CHIRO WALFOORT AZ LLC
Entity type:Organization
Organization Name:100 CHIRO WALFOORT AZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRANCHISEE
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:WALFOORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-946-4222
Mailing Address - Street 1:8787 N SCOTTSDALE RD STE 106
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-2326
Mailing Address - Country:US
Mailing Address - Phone:602-946-4222
Mailing Address - Fax:
Practice Address - Street 1:8787 N SCOTTSDALE RD STE 106
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85253-2326
Practice Address - Country:US
Practice Address - Phone:602-946-4222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty