Healthcare Provider Details

I. General information

NPI: 1104022722
Provider Name (Legal Business Name): STRETCH TO WIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 S RURAL RD STE 4N
TEMPE AZ
85282-2442
US

IV. Provider business mailing address

2525 S RURAL RD STE 4N
TEMPE AZ
85282-2442
US

V. Phone/Fax

Practice location:
  • Phone: 480-394-0440
  • Fax: 480-394-0441
Mailing address:
  • Phone: 480-394-0440
  • Fax: 480-394-0441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: CHRIS FREDERICK
Title or Position: OWNER
Credential: PT
Phone: 480-394-0440