MEDICARE: RALLY FOR ROUND TWO PLLC

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	111N00000X	Chiropractor	7804	AZ

General Provider Information

NPI Number	:	1568737377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RALLY FOR ROUND TWO PLLC

Provider Business Mailing Address
First Line	:	21050 N TATUM BLVD
Second Line	:	SUITE 114
City	:	PHOENIX
State	:	AZ
Zip	:	85050-4260
Country	:	US
Telephone Number	:	480-585-7463
Fax Number	:

Provider Business Practice Location Address
First Line	:	21050 N TATUM BLVD
Second Line	:	SUITE 114
City	:	PHOENIX
State	:	AZ
Zip	:	85050-4260
Country	:	US
Telephone Number	:	480-585-7463
Fax Number	:

Authorized Official
Title or Position	:	OWNER DOCTOR
Name	:	DR. AARON LAWRENCE WIEGAND
Credential	:	DC
Telephone Number	:	602-377-3122

Provider Enumeration Date	:	03/12/2012
Last Update Date	:	06/05/2012

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