Healthcare Provider Details

I. General information

NPI: 1407157001
Provider Name (Legal Business Name): COYOTE CHIROPRACTIC & WELLNESS CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2010
Last Update Date: 11/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3006 S. RURAL RD
TEMPE AZ
85282
US

IV. Provider business mailing address

3006 S. RURAL RD
TEMPE AZ
85282
US

V. Phone/Fax

Practice location:
  • Phone: 480-820-0999
  • Fax: 480-557-4546
Mailing address:
  • Phone: 480-820-0999
  • Fax: 480-557-4546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6073
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5997
License Number StateAZ

VIII. Authorized Official

Name: DAVID M MERCHANT
Title or Position: CEO
Credential: D.C.
Phone: 480-820-0999