Healthcare Provider Details

I. General information

NPI: 1447560933
Provider Name (Legal Business Name): WARRIOR RESTORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 10/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4710 N 44TH ST
PHOENIX AZ
85018-3834
US

IV. Provider business mailing address

4710 N 44TH ST
PHOENIX AZ
85018-3834
US

V. Phone/Fax

Practice location:
  • Phone: 602-840-3430
  • Fax: 602-522-1800
Mailing address:
  • Phone: 602-840-3430
  • Fax: 602-522-1800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7207
License Number StateAZ

VIII. Authorized Official

Name: DIANA FELICIANO
Title or Position: BILLING MANAGER
Credential:
Phone: 480-334-6646