Provider Demographics
NPI:1396922043
Name:DESERT OASIS WELLNESS, LLC
Entity type:Organization
Organization Name:DESERT OASIS WELLNESS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:RANDOLPH
Authorized Official - Last Name:JES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:520-423-2601
Mailing Address - Street 1:139 W COTTONWOOD LN
Mailing Address - Street 2:SUITE 107
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-2513
Mailing Address - Country:US
Mailing Address - Phone:520-423-2601
Mailing Address - Fax:520-876-4599
Practice Address - Street 1:139 W COTTONWOOD LN
Practice Address - Street 2:SUITE 107
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-2513
Practice Address - Country:US
Practice Address - Phone:520-423-2601
Practice Address - Fax:520-876-4599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7519111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty