Provider Demographics
NPI:1770703084
Name:TANQUE VERDE CHIROPRACTIC CLINIC P.C.
Entity type:Organization
Organization Name:TANQUE VERDE CHIROPRACTIC CLINIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DABCI
Authorized Official - Phone:520-749-2929
Mailing Address - Street 1:9100 E TANQUE VERDE RD STE 140
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85749-8173
Mailing Address - Country:US
Mailing Address - Phone:520-749-2929
Mailing Address - Fax:520-749-8391
Practice Address - Street 1:9100 E TANQUE VERDE RD
Practice Address - Street 2:STE 140
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85749-8173
Practice Address - Country:US
Practice Address - Phone:520-749-2929
Practice Address - Fax:520-749-8391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4880111N00000X, 111NI0900X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered111NI0900XChiropractic ProvidersChiropractorInternistGroup - Multi-Specialty
Not Answered111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0241060OtherBLUE CROSS BLUE SHIELD
AZAZ0241060OtherBLUE CROSS BLUE SHIELD