Healthcare Provider Details

I. General information

NPI: 1710164355
Provider Name (Legal Business Name): WEST VALLEY WELLNESS AND REHABILITATION PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2008
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9150 W INDIAN SCHOOL RD STE 138
PHOENIX AZ
85037-2384
US

IV. Provider business mailing address

9150 W INDIAN SCHOOL RD STE 138
PHOENIX AZ
85037-1904
US

V. Phone/Fax

Practice location:
  • Phone: 623-772-1444
  • Fax: 623-772-1333
Mailing address:
  • Phone: 623-772-1444
  • Fax: 623-772-1333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number7303
License Number StateAZ

VIII. Authorized Official

Name: DR. JASON CURTIS NIELSON
Title or Position: DOCTOR/OWNNER
Credential: DC
Phone: 623-772-1444