Healthcare Provider Details

I. General information

NPI: 1114016557
Provider Name (Legal Business Name): SCOTTSDALE CHIROPRACTIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2765 N. SCOTTSDALE ROAD SUITE 108
SCOTTSDALE AZ
85257
US

IV. Provider business mailing address

2765 N. SCOTTSDALE ROAD SUITE 108
SCOTTSDALE AZ
85257
US

V. Phone/Fax

Practice location:
  • Phone: 480-990-1818
  • Fax: 480-947-5797
Mailing address:
  • Phone: 480-990-1818
  • Fax: 480-947-5797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberAZ4757
License Number StateAZ

VIII. Authorized Official

Name: DR. ROBERT F. LEIBMANN
Title or Position: CEO
Credential: D.C.
Phone: 480-949-1630