Healthcare Provider Details

I. General information

NPI: 1083221634
Provider Name (Legal Business Name): REDIRECT HEALTH CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16390 N 59TH AVE STE 200
GLENDALE AZ
85306-1711
US

IV. Provider business mailing address

13430 N SCOTTSDALE RD STE 200
SCOTTSDALE AZ
85254-4058
US

V. Phone/Fax

Practice location:
  • Phone: 623-334-4000
  • Fax:
Mailing address:
  • Phone: 623-334-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JANICE G JOHNSTON
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 623-334-4000