Healthcare Provider Details

I. General information

NPI: 1437223492
Provider Name (Legal Business Name): AXIS CHIROPRACTIC CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 09/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13636 N TATUM BLVD SUITE 15
PHOENIX AZ
85032
US

IV. Provider business mailing address

13636 N TATUM BLVD SUITE 15
PHOENIX AZ
85032
US

V. Phone/Fax

Practice location:
  • Phone: 602-404-8735
  • Fax: 602-404-8736
Mailing address:
  • Phone: 602-404-8735
  • Fax: 602-404-8736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number5637
License Number StateAZ

VIII. Authorized Official

Name: JONATHAN J BELTRAMINI
Title or Position: PRESIDENT
Credential: DC
Phone: 602-404-8735