Provider Demographics
NPI:1770735656
Name:TOTAL LIFESTYLE CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:TOTAL LIFESTYLE CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CHIROPRACTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BLADOW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-368-2639
Mailing Address - Street 1:7032 E COCHISE RD
Mailing Address - Street 2:STE A130
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-4546
Mailing Address - Country:US
Mailing Address - Phone:480-368-2639
Mailing Address - Fax:480-368-2643
Practice Address - Street 1:7032 E COCHISE RD
Practice Address - Street 2:STE A130
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85253-4546
Practice Address - Country:US
Practice Address - Phone:480-368-2639
Practice Address - Fax:480-368-2643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7965111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty