Healthcare Provider Details

I. General information

NPI: 1356022214
Provider Name (Legal Business Name): CHRISTOPHER SCOTT CHURCH LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13295 W MEEKER BLVD SUITE 9
SUN CITY WEST AZ
85381-4242
US

IV. Provider business mailing address

16636 N 176TH LN
SURPRISE AZ
85388-3123
US

V. Phone/Fax

Practice location:
  • Phone: 480-780-4040
  • Fax: 480-780-0406
Mailing address:
  • Phone: 480-780-4040
  • Fax: 480-780-0406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC-25049
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: