Healthcare Provider Details

I. General information

NPI: 1730372194
Provider Name (Legal Business Name): GRAYHAWK FAMILY CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 04/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8714 E VISTA BONITA DR SUITE 101
SCOTTSDALE AZ
85255-4249
US

IV. Provider business mailing address

8714 E VISTA BONITA DR SUITE 101
SCOTTSDALE AZ
85255-4249
US

V. Phone/Fax

Practice location:
  • Phone: 480-247-9063
  • Fax: 480-247-9974
Mailing address:
  • Phone: 480-247-9063
  • Fax: 480-247-9974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7796
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9312PT
License Number StateAZ

VIII. Authorized Official

Name: DR. FRANK SORRENTINO
Title or Position: STATUTORY AGENT
Credential: D.C.
Phone: 480-247-9063