=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114016557
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SCOTTSDALE CHIROPRACTIC, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2006
-----------------------------------------------------
Last Update Date | 07/15/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2765 N. SCOTTSDALE ROAD SUITE 108
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85257
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-990-1818
-----------------------------------------------------
Fax | 480-947-5797
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2765 N. SCOTTSDALE ROAD SUITE 108
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85257
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-990-1818
-----------------------------------------------------
Fax | 480-947-5797
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. ROBERT F. LEIBMANN
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 480-949-1630
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | AZ4757
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------