Healthcare Provider Details

I. General information

NPI: 1104513803
Provider Name (Legal Business Name): CASA GRANDE COMMUNITY ACUPUNCTURE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2023
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 W 10TH ST STE 2
CASA GRANDE AZ
85122-3940
US

IV. Provider business mailing address

474 N OXFORD LN
CHANDLER AZ
85225-4820
US

V. Phone/Fax

Practice location:
  • Phone: 520-222-7385
  • Fax: 866-727-9116
Mailing address:
  • Phone: 480-822-8456
  • Fax: 866-727-9116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AUBREY EUGENA BACKARIC
Title or Position: OWNER
Credential: DC
Phone: 520-222-7385