MEDICARE: PHOENIX CHIROPRACTIC CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NR0400X	Rehabilitation Chiropractor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1154351450	OTHER	AZ	NPI

General Provider Information

NPI Number	:	1154351450
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX CHIROPRACTIC CORP

Provider Business Mailing Address
First Line	:	1450 W GUADALUPE RD
Second Line	:	STE 120
City	:	GILBERT
State	:	AZ
Zip	:	85233-3042
Country	:	US
Telephone Number	:	480-926-7800
Fax Number	:	480-926-2260

Provider Business Practice Location Address
First Line	:	2824 E INDIAN SCHOOL RD
Second Line	:	STE 5
City	:	PHOENIX
State	:	AZ
Zip	:	85016-6863
Country	:	US
Telephone Number	:	602-840-0056
Fax Number	:	602-840-4056

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. MINOO RAHIMINEJAD
Credential	:
Telephone Number	:	480-926-7800

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	03/06/2008

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Directions to “PHOENIX CHIROPRACTIC CORP ” Practice Location

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