Provider Demographics
NPI:1457570749
Name:DEMENT FAMILY CHIROPRACTIC TRUST
Entity Type:Organization
Organization Name:DEMENT FAMILY CHIROPRACTIC TRUST
Other - Org Name:DEMENT FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TRUSTEE
Authorized Official - Prefix:DR
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:DEMENT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:520-298-4999
Mailing Address - Street 1:6520 E CARONDELET DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-2117
Mailing Address - Country:US
Mailing Address - Phone:520-298-4999
Mailing Address - Fax:
Practice Address - Street 1:6520 E CARONDELET DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-2117
Practice Address - Country:US
Practice Address - Phone:520-298-4999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ67182Medicare PIN