Healthcare Provider Details

I. General information

NPI: 1659425395
Provider Name (Legal Business Name): CAS CHIROPRACTIC & REHABILITATON CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 12/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4619 N 24TH ST
PHOENIX AZ
85016-5203
US

IV. Provider business mailing address

2330 N 75TH AVE STE 104
PHOENIX AZ
85035-1200
US

V. Phone/Fax

Practice location:
  • Phone: 602-956-0111
  • Fax: 602-956-6789
Mailing address:
  • Phone: 623-849-9416
  • Fax: 623-849-9622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7068
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3744
License Number StateAZ

VIII. Authorized Official

Name: MARTIN R MOFFETT
Title or Position: CO-OWNER
Credential: D.C.
Phone: 623-849-9416