Healthcare Provider Details

I. General information

NPI: 1922467489
Provider Name (Legal Business Name): PRIMARY REACH CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2016
Last Update Date: 02/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5527 N 27TH AVE
PHOENIX AZ
85017-2602
US

IV. Provider business mailing address

5527 N 27TH AVE
PHOENIX AZ
85017-2602
US

V. Phone/Fax

Practice location:
  • Phone: 602-242-2370
  • Fax:
Mailing address:
  • Phone: 602-242-2370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8372
License Number StateAZ

VIII. Authorized Official

Name: BRANDON KULP
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 602-242-2370