Healthcare Provider Details

I. General information

NPI: 1598572562
Provider Name (Legal Business Name): MOVE FREE CHIROPRATIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2024
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 E SOUTHERN AVE STE 3
TEMPE AZ
85282-5483
US

IV. Provider business mailing address

1050 E SOUTHERN AVE STE 3
TEMPE AZ
85282-5483
US

V. Phone/Fax

Practice location:
  • Phone: 602-529-4383
  • Fax: 602-532-7443
Mailing address:
  • Phone: 602-529-4383
  • Fax: 602-532-7443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. MITCHELL GERARD FASSAERT
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 602-529-4383