Provider Demographics
NPI:1831363571
Name:EAST VALLEY CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:EAST VALLEY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOWALCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-892-7500
Mailing Address - Street 1:201 W GUADALUPE RD STE 301
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-3333
Mailing Address - Country:US
Mailing Address - Phone:480-892-7500
Mailing Address - Fax:
Practice Address - Street 1:201 W GUADALUPE RD STE 301
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-3333
Practice Address - Country:US
Practice Address - Phone:480-892-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7489111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty