Provider Demographics
NPI:1477358356
Name:ARIZONA INTEGRATIVE MEDICAL
Entity type:Organization
Organization Name:ARIZONA INTEGRATIVE MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:PAGE
Authorized Official - Last Name:WATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-580-9690
Mailing Address - Street 1:980 E PECOS RD STE 3
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-2438
Mailing Address - Country:US
Mailing Address - Phone:801-580-9690
Mailing Address - Fax:
Practice Address - Street 1:14424 S CANVASBACK LN
Practice Address - Street 2:
Practice Address - City:BLUFFDALE
Practice Address - State:UT
Practice Address - Zip Code:84065-1762
Practice Address - Country:US
Practice Address - Phone:801-580-9690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-15
Last Update Date:2025-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty