Healthcare Provider Details

I. General information

NPI: 1538465620
Provider Name (Legal Business Name): A ALYESH CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2011
Last Update Date: 02/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1427 E BELL RD STE 104
PHOENIX AZ
85022-2712
US

IV. Provider business mailing address

1427 E BELL RD STE 104
PHOENIX AZ
85022-2712
US

V. Phone/Fax

Practice location:
  • Phone: 602-863-9003
  • Fax: 602-993-3014
Mailing address:
  • Phone: 602-863-9003
  • Fax: 602-993-3014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4131
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number4131
License Number StateAZ

VIII. Authorized Official

Name: ALBERT ALYESHMERNI
Title or Position: PRESIDENT
Credential: DC
Phone: 602-863-9003