Healthcare Provider Details

I. General information

NPI: 1356401368
Provider Name (Legal Business Name): MUSCLE RESTORATION AND CHIROPRACTIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10613 N HAYDEN RD STE J107
SCOTTSDALE AZ
85260-5576
US

IV. Provider business mailing address

4432 E DANBURY RD
PHOENIX AZ
85032-2362
US

V. Phone/Fax

Practice location:
  • Phone: 602-717-7465
  • Fax:
Mailing address:
  • Phone: 602-717-7465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM FRANK PHATUROS
Title or Position: PRESIDENT
Credential: DC
Phone: 602-717-7465