Healthcare Provider Details

I. General information

NPI: 1902294614
Provider Name (Legal Business Name): IRONWOOD CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2015
Last Update Date: 04/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 W COMBS RD STE 109
SAN TAN VALLEY AZ
85140-9107
US

IV. Provider business mailing address

85 W COMBS RD STE 109
SAN TAN VALLEY AZ
85140-9107
US

V. Phone/Fax

Practice location:
  • Phone: 480-882-9105
  • Fax: 480-458-5833
Mailing address:
  • Phone: 480-882-9105
  • Fax: 480-458-5833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7506
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7506
License Number StateAZ

VIII. Authorized Official

Name: CHRISTOPHER RAY BUTLER
Title or Position: PRESIDENT
Credential: D.C.
Phone: 480-433-8294