Provider Demographics
NPI:1881945517
Name:NORTH VALLEY CHIROPRACTIC CENTER PC
Entity type:Organization
Organization Name:NORTH VALLEY CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:E
Authorized Official - Last Name:BRIDGES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:602-867-1797
Mailing Address - Street 1:4545 E SHEA BLVD
Mailing Address - Street 2:STE 174
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3074
Mailing Address - Country:US
Mailing Address - Phone:602-867-1797
Mailing Address - Fax:602-254-6735
Practice Address - Street 1:4545 E SHEA BLVD
Practice Address - Street 2:STE 174
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3074
Practice Address - Country:US
Practice Address - Phone:602-867-1797
Practice Address - Fax:602-254-6735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-20
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2002261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service