Healthcare Provider Details

I. General information

NPI: 1760296271
Provider Name (Legal Business Name): LOCAL CHIROPRACTIC STUDIO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 S VAL VISTA DR STE 126
MESA AZ
85204-7372
US

IV. Provider business mailing address

1955 S VAL VISTA DR STE 126
MESA AZ
85204-7372
US

V. Phone/Fax

Practice location:
  • Phone: 480-944-2434
  • Fax: 630-388-0639
Mailing address:
  • Phone: 480-944-2434
  • Fax: 630-388-0639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DALESA CLAY
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 480-570-5423