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General NPI Number Information
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NPI Number | 1053566018
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Entity Type | Organization
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Legal Business Name | ADVANCED CHIROPRACTIC AND ALLERGY RELIEF
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Dates
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Enumeration Date | 11/18/2008
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Last Update Date | 11/18/2008
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Provider Practice Location Address
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Address Line | 3305 E. GREENWAY RD. #7
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City | PHOENIX
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State | AZ
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Zip | 85032
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Country | US
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Telephone | 602-866-3500
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Fax |
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Provider Business Mailing Address
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Address Line | 3305 E. GREENWAY RD. #7
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City | PHOENIX
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State | AZ
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Zip | 85032
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. DYLAN FOSTER
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Credential | D.C.
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Telephone | 602-866-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 5775
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License Number State | AZ
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