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General NPI Number Information
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NPI Number | 1073001590
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Entity Type | Organization
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Legal Business Name | CROTALUS CHIROPRACTIC CENTERS, PLC
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Dates
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Enumeration Date | 04/30/2018
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Last Update Date | 05/22/2020
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Provider Practice Location Address
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Address Line | 3540 E BASELINE RD STE 117
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City | PHOENIX
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State | AZ
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Zip | 85042-9628
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Country | US
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Telephone | 602-777-7970
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Fax | 877-771-6086
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Provider Business Mailing Address
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Address Line | 3540 E BASELINE RD STE 117
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City | PHOENIX
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State | AZ
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Zip | 85042-9628
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Country | US
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Telephone | 602-777-7970
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Fax | 877-771-6086
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. BRENDAN PATRICK O'CONNOR
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Credential | D.C.
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Telephone | 602-777-7970
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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 | 6095
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License Number State | AZ
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