Provider Demographics
NPI:1649319047
Name:STATE OF THE ART CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:STATE OF THE ART CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:COLLOCA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-893-2400
Mailing Address - Street 1:11011 S 48TH ST
Mailing Address - Street 2:STE 220
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-1779
Mailing Address - Country:US
Mailing Address - Phone:480-893-2400
Mailing Address - Fax:480-893-2412
Practice Address - Street 1:11011 S 48TH ST
Practice Address - Street 2:STE 220
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-1779
Practice Address - Country:US
Practice Address - Phone:480-893-2400
Practice Address - Fax:480-893-2412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5609111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU58893Medicare UPIN
AZZ28511Medicare PIN