Healthcare Provider Details

I. General information

NPI: 1033374459
Provider Name (Legal Business Name): NATURAL CHOICE FAMILY WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 09/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 S MAIN ST STE A
SNOWFLAKE AZ
85937-5606
US

IV. Provider business mailing address

1300 S MAIN ST STE A
SNOWFLAKE AZ
85937-5606
US

V. Phone/Fax

Practice location:
  • Phone: 928-536-5525
  • Fax: 928-536-3010
Mailing address:
  • Phone: 928-536-5525
  • Fax: 928-536-3010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: DR. JUSTIN JAMES WOODSIDE
Title or Position: PRESIDENT/CHIROPRACTOR
Credential: D.C.
Phone: 928-536-5525