Provider Demographics
NPI:1811948425
Name:ASSURANCE CHIROPRACTIC INC
Entity type:Organization
Organization Name:ASSURANCE CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:ST GEORGE
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:928-646-9220
Mailing Address - Street 1:4141 WESTERN DRI
Mailing Address - Street 2:SUITE D
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326
Mailing Address - Country:US
Mailing Address - Phone:928-646-9220
Mailing Address - Fax:928-646-7266
Practice Address - Street 1:4141 WESTERN DR
Practice Address - Street 2:SUITE D
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326
Practice Address - Country:US
Practice Address - Phone:928-646-9220
Practice Address - Fax:928-646-7266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T76915Medicare UPIN