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General NPI Number Information
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NPI Number | 1144304627
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Entity Type | Organization
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Legal Business Name | LORD CHIROPRACTIC CENTER LTD
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 03/18/2010
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Provider Practice Location Address
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Address Line | 5041 W NORTHERN AVE SUITE A
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City | GLENDALE
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State | AZ
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Zip | 85301-1539
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Country | US
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Telephone | 623-939-8325
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Fax |
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Provider Business Mailing Address
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Address Line | 5041 W NORTHERN AVE SUITE A
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City | GLENDALE
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State | AZ
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Zip | 85301-1539
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Country | US
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Telephone | 623-939-8325
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEAN ALICE LORD
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Credential | DC
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Telephone | 623-939-8325
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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 | 416
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License Number State | AZ
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