Provider Demographics
NPI:1265762504
Name:INJURY & ACCIDENT CHIROPRACTIC CLINIC, LLC
Entity type:Organization
Organization Name:INJURY & ACCIDENT CHIROPRACTIC CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:C
Authorized Official - Last Name:MANOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:520-312-9796
Mailing Address - Street 1:5151 N ORACLE RD STE 129
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-3757
Mailing Address - Country:US
Mailing Address - Phone:520-408-4900
Mailing Address - Fax:520-408-6903
Practice Address - Street 1:5151 N ORACLE RD STE 129
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-3757
Practice Address - Country:US
Practice Address - Phone:520-408-4900
Practice Address - Fax:520-408-6903
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONSTRUCTION AND FINANCIAL SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-08
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8051111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty