Healthcare Provider Details

I. General information

NPI: 1558995027
Provider Name (Legal Business Name): JOSE J CRUZ DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2020
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9150 W INDIAN SCHOOL RD STE 118
PHOENIX AZ
85037-2387
US

IV. Provider business mailing address

11485 N LUCKENBACH ST
SURPRISE AZ
85388-3026
US

V. Phone/Fax

Practice location:
  • Phone: 602-815-1519
  • Fax: 480-284-8972
Mailing address:
  • Phone: 787-934-6759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8899
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number8899
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number8899
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number8899
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number8899
License Number StateAZ
# 6
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number8899
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: