Healthcare Provider Details

I. General information

NPI: 1104937838
Provider Name (Legal Business Name): CHIROPRACTIC WORKS WEST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 10/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 N SCOTTSDALE RD
SCOTTSDALE AZ
85257-1352
US

IV. Provider business mailing address

854 RAVINE TERRACE DR
ROCHESTER HILLS MI
48307-2721
US

V. Phone/Fax

Practice location:
  • Phone: 480-284-9072
  • Fax:
Mailing address:
  • Phone: 480-284-9072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number3629
License Number StateAZ

VIII. Authorized Official

Name: DR. RAYMOND J HILLENBRAND
Title or Position: CHIROPRACTIOR
Credential: D.C.
Phone: 480-284-9072