Healthcare Provider Details

I. General information

NPI: 1437583853
Provider Name (Legal Business Name): AZ BODY MECHANICS- HIGH ST PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2013
Last Update Date: 08/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5410 E HIGH ST SUITE 107
PHOENIX AZ
85054-5456
US

IV. Provider business mailing address

4127 E PULLMAN RD
CAVE CREEK AZ
85331-4007
US

V. Phone/Fax

Practice location:
  • Phone: 480-282-8485
  • Fax: 480-323-2777
Mailing address:
  • Phone: 480-282-8485
  • Fax: 480-323-2777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number7685
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4369
License Number StateAZ

VIII. Authorized Official

Name: STACEY DEWOLF
Title or Position: OWNER
Credential: DC
Phone: 480-282-8485