Healthcare Provider Details

I. General information

NPI: 1164978698
Provider Name (Legal Business Name): ARIZONA SPORTS CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2016
Last Update Date: 08/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 E BELL RD STE. 152 BLDG. 6
PHOENIX AZ
85032-9306
US

IV. Provider business mailing address

4550 E BELL RD STE. 152 BLDG. 6
PHOENIX AZ
85032-9306
US

V. Phone/Fax

Practice location:
  • Phone: 602-258-9663
  • Fax: 602-258-9664
Mailing address:
  • Phone: 602-258-9663
  • Fax: 602-258-9664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number5233
License Number StateAZ

VIII. Authorized Official

Name: DR. CHRISTOPHER RAY WOOD
Title or Position: PRESIDENT
Credential: D.C.
Phone: 602-258-9663