Provider Demographics
NPI:1356580682
Name:AZ CHIRO LLC
Entity type:Organization
Organization Name:AZ CHIRO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:BLAKE
Authorized Official - Last Name:BIDDULPH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-802-9900
Mailing Address - Street 1:20403 N LAKE PLEASANT RD
Mailing Address - Street 2:STE 117-202
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-9702
Mailing Address - Country:US
Mailing Address - Phone:623-986-0343
Mailing Address - Fax:
Practice Address - Street 1:8996 W UNION HILLS DR
Practice Address - Street 2:STE 103
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-3010
Practice Address - Country:US
Practice Address - Phone:623-986-0343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-10
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty