Healthcare Provider Details

I. General information

NPI: 1457865420
Provider Name (Legal Business Name): NBC OPERATIONS-PHOENIX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2017
Last Update Date: 11/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6750 W THUNDERBIRD RD STE B-101
PEORIA AZ
85381-5026
US

IV. Provider business mailing address

8678 SPRING MOUNTAIN RD STE 110
LAS VEGAS NV
89117-4103
US

V. Phone/Fax

Practice location:
  • Phone: 602-368-1333
  • Fax: 602-368-9373
Mailing address:
  • Phone: 702-644-3333
  • Fax: 702-644-3336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateAZ

VIII. Authorized Official

Name: MS. JULIE KESTNER
Title or Position: CHIEF FINANCIAL OFFER
Credential: CPA, CFO
Phone: 702-644-3333