Provider Demographics
NPI:1811172687
Name:INFINITE WELLNESS CHIROPRACTIC
Entity type:Organization
Organization Name:INFINITE WELLNESS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TARE
Authorized Official - Middle Name:C
Authorized Official - Last Name:GURIRA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-926-0888
Mailing Address - Street 1:1094 S GILBERT RD
Mailing Address - Street 2:BLDG. B-2 SUITE 103
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-3445
Mailing Address - Country:US
Mailing Address - Phone:480-926-0888
Mailing Address - Fax:480-926-0886
Practice Address - Street 1:1094 S GILBERT RD
Practice Address - Street 2:BLDG. B-2 SUITE 103
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-3445
Practice Address - Country:US
Practice Address - Phone:480-926-0888
Practice Address - Fax:480-926-0886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-29
Last Update Date:2007-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7229111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty