Provider Demographics
NPI:1396924551
Name:WRIGHT CHIROPRACTIC LLC
Entity type:Organization
Organization Name:WRIGHT CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-222-6059
Mailing Address - Street 1:633 E RAY RD
Mailing Address - Street 2:STE 110
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-4202
Mailing Address - Country:US
Mailing Address - Phone:480-222-6059
Mailing Address - Fax:480-664-2093
Practice Address - Street 1:633 E RAY RD
Practice Address - Street 2:STE 110
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-4202
Practice Address - Country:US
Practice Address - Phone:480-222-6059
Practice Address - Fax:480-664-2093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4012261QR0400X
AZ7327261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4012OtherPHYSIOTHERAPY CERTIFICATE
AZ7327OtherCHIROPRACTIC LICENSE
AZAZ0942090OtherBLUE CROSS BLUE SHIELD
AZ4012OtherPHYSIOTHERAPY CERTIFICATE
AZU96927Medicare UPIN