Healthcare Provider Details

I. General information

NPI: 1407911373
Provider Name (Legal Business Name): CAS CHIROPRACTIC CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2006
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

4619 N 24TH ST
PHOENIX AZ
85016-5203
US

V. Phone/Fax

Practice location:
  • Phone: 602-956-0111
  • Fax: 602-956-6789
Mailing address:
  • Phone: 602-956-0111
  • Fax: 602-956-6789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number3030
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5338
License Number StateAZ

VIII. Authorized Official

Name: DR. MICHAEL J CASTRICHINI
Title or Position: OWNER
Credential: DC
Phone: 602-956-0111