Healthcare Provider Details

I. General information

NPI: 1154675239
Provider Name (Legal Business Name): BREWER CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2012
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

581 E OLD LINDEN RD
SHOW LOW AZ
85901-4825
US

IV. Provider business mailing address

581 E OLD LINDEN RD
SHOW LOW AZ
85901-4825
US

V. Phone/Fax

Practice location:
  • Phone: 928-537-2600
  • Fax: 928-337-3291
Mailing address:
  • Phone: 928-537-2600
  • Fax: 928-337-3291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number7695
License Number StateAZ

VIII. Authorized Official

Name: VIRGENE J UGWU
Title or Position: OFFICE MANAGER
Credential:
Phone: 928-337-3125