Healthcare Provider Details

I. General information

NPI: 1437488574
Provider Name (Legal Business Name): KALETA FAMILY CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2009
Last Update Date: 12/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34406 N 27TH DR SUITE 108
PHOENIX AZ
85085-6082
US

IV. Provider business mailing address

34406 N 27TH DR SUITE 108
PHOENIX AZ
85085-6082
US

V. Phone/Fax

Practice location:
  • Phone: 623-266-1700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8065
License Number StateAZ

VIII. Authorized Official

Name: IRMA J KALETA
Title or Position: PROVIDER/OWNER
Credential: D.C.
Phone: 623-266-1700