Provider Demographics
NPI:1265802086
Name:POWELL CHIROPRACTIC HEALTH CENTER
Entity type:Organization
Organization Name:POWELL CHIROPRACTIC HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:R
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:623-873-4444
Mailing Address - Street 1:7575 W PEORIA AVE
Mailing Address - Street 2:SUITE A-106
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-5873
Mailing Address - Country:US
Mailing Address - Phone:623-873-4444
Mailing Address - Fax:623-979-8515
Practice Address - Street 1:7575 W PEORIA AVE
Practice Address - Street 2:SUITE A-106
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-5873
Practice Address - Country:US
Practice Address - Phone:623-873-4444
Practice Address - Fax:623-979-8515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4767111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZDC4767OtherPTAN