Healthcare Provider Details

I. General information

NPI: 1093839920
Provider Name (Legal Business Name): HEALING HAVENS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2007
Last Update Date: 01/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 N 19TH AVE SUITE E
PHOENIX AZ
85015-2903
US

IV. Provider business mailing address

5225 N 19TH AVE SUITE E
PHOENIX AZ
85015-2903
US

V. Phone/Fax

Practice location:
  • Phone: 602-841-7576
  • Fax:
Mailing address:
  • Phone: 602-841-7576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number8052
License Number StateAZ

VIII. Authorized Official

Name: ZAHER HAJO
Title or Position: PRESIDENT
Credential: DC
Phone: 602-841-7576