Provider Demographics
NPI:1255421970
Name:CHIROPRACTIC FITNESS CENTER
Entity type:Organization
Organization Name:CHIROPRACTIC FITNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:BIRT
Authorized Official - Last Name:CHANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:928-778-6200
Mailing Address - Street 1:9870 S 46TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-5533
Mailing Address - Country:US
Mailing Address - Phone:928-778-6200
Mailing Address - Fax:928-778-9034
Practice Address - Street 1:809 GAIL GARDNER WAY STE B
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-1801
Practice Address - Country:US
Practice Address - Phone:928-778-6200
Practice Address - Fax:928-778-9034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7082111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0938370OtherBLUE CROSS BLUE SHIELD
AZ76213Medicare ID - Type UnspecifiedCHIROPRACTIC