Healthcare Provider Details

I. General information

NPI: 1699889097
Provider Name (Legal Business Name): PHILLIP JAMES POKORNY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S IDAHO RD SUITE 140
APACHE JUNCTION AZ
85219-2379
US

IV. Provider business mailing address

110 S IDAHO RD SUITE 140
APACHE JUNCTION AZ
85219-2379
US

V. Phone/Fax

Practice location:
  • Phone: 480-671-5655
  • Fax: 480-617-5705
Mailing address:
  • Phone: 480-671-5655
  • Fax: 480-617-5705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5604
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: