Healthcare Provider Details

I. General information

NPI: 1952425589
Provider Name (Legal Business Name): LAKE PLEASANT CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9059 W LAKE PLEASANT PKWY SUITE 700
PEORIA AZ
85382-8336
US

IV. Provider business mailing address

9059 W LAKE PLEASANT PKWY SUITE 700
PEORIA AZ
85382-8336
US

V. Phone/Fax

Practice location:
  • Phone: 623-572-4476
  • Fax: 623-566-4918
Mailing address:
  • Phone: 623-572-4476
  • Fax: 623-566-4918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7439
License Number StateAZ

VIII. Authorized Official

Name: DR. MELANIE DIAS-ZAIR
Title or Position: PRESIDENT
Credential: D.C.
Phone: 623-572-4476