Healthcare Provider Details

I. General information

NPI: 1689970113
Provider Name (Legal Business Name): PHOENIX FAMILY WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2011
Last Update Date: 05/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20811 N CAVE CREEK RD #103
PHOENIX AZ
85024-4461
US

IV. Provider business mailing address

20235 N CAVE CREEK RD #104-459
PHOENIX AZ
85024-4424
US

V. Phone/Fax

Practice location:
  • Phone: 602-569-7000
  • Fax: 602-569-7001
Mailing address:
  • Phone: 602-569-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7909
License Number StateAZ

VIII. Authorized Official

Name: DR. LORA Y WALFOORT
Title or Position: DIRECTOR
Credential: DC
Phone: 602-569-7000