Healthcare Provider Details

I. General information

NPI: 1053684498
Provider Name (Legal Business Name): SUNNY VIEW MEDICAL CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2012
Last Update Date: 02/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 N 32ND ST SUITE 110
PHOENIX AZ
85018-3953
US

IV. Provider business mailing address

4400 N 32ND ST SUITE 110
PHOENIX AZ
85018-3953
US

V. Phone/Fax

Practice location:
  • Phone: 602-956-9595
  • Fax: 602-956-3232
Mailing address:
  • Phone: 602-956-9595
  • Fax: 602-956-3232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberAZ5729
License Number StateAZ

VIII. Authorized Official

Name: SAMUEL TERRY CLARK
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 602-956-9595