Healthcare Provider Details

I. General information

NPI: 1497626287
Provider Name (Legal Business Name): EMILLIE ROSE CASTRICHINI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4619 N 24TH ST
PHOENIX AZ
85016-5203
US

IV. Provider business mailing address

5501 E ROADRUNNER RD
PARADISE VALLEY AZ
85253-3330
US

V. Phone/Fax

Practice location:
  • Phone: 602-956-0111
  • Fax:
Mailing address:
  • Phone: 602-956-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number9491
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: