Healthcare Provider Details

I. General information

NPI: 1962693986
Provider Name (Legal Business Name): JUSTIN RONALD WRIGHT D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 07/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9971 W CAMELBACK RD SUITE 105
PHOENIX AZ
85037-5011
US

IV. Provider business mailing address

4432 N MILLER RD SUITE 102
SCOTTSDALE AZ
85251-3697
US

V. Phone/Fax

Practice location:
  • Phone: 623-872-0002
  • Fax: 623-872-1112
Mailing address:
  • Phone: 480-945-0008
  • Fax: 480-945-2778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7361
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: