Healthcare Provider Details

I. General information

NPI: 1811172687
Provider Name (Legal Business Name): INFINITE WELLNESS CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2007
Last Update Date: 12/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1094 S GILBERT RD BLDG. B-2 SUITE 103
GILBERT AZ
85296-3445
US

IV. Provider business mailing address

1094 S GILBERT RD BLDG. B-2 SUITE 103
GILBERT AZ
85296-3445
US

V. Phone/Fax

Practice location:
  • Phone: 480-926-0888
  • Fax: 480-926-0886
Mailing address:
  • Phone: 480-926-0888
  • Fax: 480-926-0886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number7229
License Number StateAZ

VIII. Authorized Official

Name: MR. TARE C GURIRA
Title or Position: OWNER
Credential: D.C.
Phone: 480-926-0888