Healthcare Provider Details

I. General information

NPI: 1538451869
Provider Name (Legal Business Name): MELODY M JAFARI PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2011
Last Update Date: 05/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2814 N 36TH ST
PHOENIX AZ
85008-1303
US

IV. Provider business mailing address

2814 N 36TH ST
PHOENIX AZ
85008-1303
US

V. Phone/Fax

Practice location:
  • Phone: 602-956-5561
  • Fax: 602-956-5561
Mailing address:
  • Phone: 602-956-5561
  • Fax: 602-956-5561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6053
License Number StateAZ

VIII. Authorized Official

Name: MELODY JAFARI
Title or Position: MEMBER
Credential: D.C
Phone: 602-956-5561