Provider Demographics
NPI:1265602890
Name:CHIROPRACTIC PHYSICIANS OF PHOENIX, PLLC
Entity type:Organization
Organization Name:CHIROPRACTIC PHYSICIANS OF PHOENIX, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:MELINDA
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-998-7627
Mailing Address - Street 1:8070 E MORGAN TRL
Mailing Address - Street 2:#125
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-1227
Mailing Address - Country:US
Mailing Address - Phone:480-998-7627
Mailing Address - Fax:480-998-2309
Practice Address - Street 1:8070 E MORGAN TRL
Practice Address - Street 2:#125
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-1227
Practice Address - Country:US
Practice Address - Phone:480-998-7627
Practice Address - Fax:480-998-2309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7336111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ104266OtherGROUP PIN
AZZ128702OtherPTAN
AZ104266OtherGROUP PIN
AZU98659Medicare UPIN