Provider Demographics
NPI:1336408046
Name:PISANO, SUKKHUAN (DC)
Entity Type:Individual
Prefix:DR
First Name:SUKKHUAN
Middle Name:
Last Name:PISANO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48412 N BLACK CANYON HWY
Mailing Address - Street 2:#425
Mailing Address - City:NEW RIVER
Mailing Address - State:AZ
Mailing Address - Zip Code:85087-6911
Mailing Address - Country:US
Mailing Address - Phone:602-663-4920
Mailing Address - Fax:
Practice Address - Street 1:2735 W UNION HILLS DR
Practice Address - Street 2:SUITE 102
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-5033
Practice Address - Country:US
Practice Address - Phone:602-973-1630
Practice Address - Fax:602-973-1667
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7491111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor