MEDICARE: CRC CHIROPRACTIC,L.L.C.

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	7746	AZ

General Provider Information

NPI Number	:	1982612248
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRC CHIROPRACTIC,L.L.C.

Provider Business Mailing Address
First Line	:	4619 N 24TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-5203
Country	:	US
Telephone Number	:	602-956-0111
Fax Number	:	602-956-0720

Provider Business Practice Location Address
First Line	:	2330 N 75TH AVE
Second Line	:	STE 104
City	:	PHOENIX
State	:	AZ
Zip	:	85035-1200
Country	:	US
Telephone Number	:	623-849-9416
Fax Number	:	623-849-9622

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CARIN R CASTRO
Credential	:	D.C.
Telephone Number	:	623-849-9416

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	08/22/2020

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