Healthcare Provider Details

I. General information

NPI: 1518146224
Provider Name (Legal Business Name): ACTIVE CARE CHIROPRACTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 10/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2052 E SOUTHERN AVE
TEMPE AZ
85282-7515
US

IV. Provider business mailing address

2052 E SOUTHERN AVE
TEMPE AZ
85282-7515
US

V. Phone/Fax

Practice location:
  • Phone: 480-756-6044
  • Fax: 480-756-1107
Mailing address:
  • Phone: 480-756-6044
  • Fax: 480-756-1107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number4484
License Number StateAZ

VIII. Authorized Official

Name: DR. DONALD HILTON DEARTH
Title or Position: PRESIDENT
Credential: D.C.
Phone: 480-756-6044