Provider Demographics
NPI:1649440561
Name:INFINITE POTENTIAL CENTERS FOR HEALING, INC.
Entity type:Organization
Organization Name:INFINITE POTENTIAL CENTERS FOR HEALING, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANCUSO
Authorized Official - Suffix:
Authorized Official - Credentials:RD, DC, FICPA
Authorized Official - Phone:480-219-4439
Mailing Address - Street 1:6124 E DELCOA AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-3823
Mailing Address - Country:US
Mailing Address - Phone:480-219-4439
Mailing Address - Fax:480-219-4569
Practice Address - Street 1:6124 E DELCOA AVE
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-3823
Practice Address - Country:US
Practice Address - Phone:480-219-4439
Practice Address - Fax:480-219-4569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5988111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0941110OtherBCBS
AZZ103504Medicare PIN