Healthcare Provider Details

I. General information

NPI: 1730562638
Provider Name (Legal Business Name): INTEGRITY FAMILY WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2015
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16485 N STADIUM WAY 3001
SURPRISE AZ
85374-4376
US

IV. Provider business mailing address

16485 N STADIUM WAY 3001
SURPRISE AZ
85374-4376
US

V. Phone/Fax

Practice location:
  • Phone: 219-218-9906
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8406
License Number StateAZ

VIII. Authorized Official

Name: DR. SHENITA STAGGERS
Title or Position: PRESIDENT
Credential: DC
Phone: 219-218-9906