Provider Demographics
NPI:1396914727
Name:COMMUNITY HOLISTIC HEALTH CLINIC LTD.
Entity type:Organization
Organization Name:COMMUNITY HOLISTIC HEALTH CLINIC LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:F
Authorized Official - Last Name:LUBITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-968-7767
Mailing Address - Street 1:2504 S RURAL RD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-2429
Mailing Address - Country:US
Mailing Address - Phone:480-968-7767
Mailing Address - Fax:480-968-0955
Practice Address - Street 1:2504 S RURAL RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-2429
Practice Address - Country:US
Practice Address - Phone:480-968-7767
Practice Address - Fax:480-968-0955
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HOLISTIC HEALTH CLINIC LTD.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ888111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZT41887Medicare UPIN