Healthcare Provider Details

I. General information

NPI: 1568515583
Provider Name (Legal Business Name): KUKURIN CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2007
Last Update Date: 04/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12409 W INDIAN SCHOOL RD C304
AVONDALE AZ
85323-9502
US

IV. Provider business mailing address

14327 W MONTE VISTA RD
GOODYEAR AZ
85338-2327
US

V. Phone/Fax

Practice location:
  • Phone: 623-547-4727
  • Fax:
Mailing address:
  • Phone: 623-547-4727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number7366
License Number StateAZ

VIII. Authorized Official

Name: DR. GEORGE WILLIAM KUKURIN
Title or Position: CLINIC DIRECTOR
Credential: DC
Phone: 623-547-4727