Healthcare Provider Details

I. General information

NPI: 1396924551
Provider Name (Legal Business Name): WRIGHT CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 01/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 E RAY RD STE 110
GILBERT AZ
85296-4202
US

IV. Provider business mailing address

633 E RAY RD STE 110
GILBERT AZ
85296-4202
US

V. Phone/Fax

Practice location:
  • Phone: 480-222-6059
  • Fax: 480-664-2093
Mailing address:
  • Phone: 480-222-6059
  • Fax: 480-664-2093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number4012
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number7327
License Number StateAZ

VIII. Authorized Official

Name: BRIAN R WRIGHT
Title or Position: OWNER
Credential: DC
Phone: 480-222-6059