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General NPI Number Information
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NPI Number | 1184087579
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Entity Type | Organization
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Legal Business Name | PREMIER HEALTH AND MEDICAL
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Dates
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Enumeration Date | 04/01/2016
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Last Update Date | 09/08/2016
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Provider Practice Location Address
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Address Line | 20851 E RITTENHOUSE RD E103
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-4493
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Country | US
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Telephone | 480-677-2800
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Fax |
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Provider Business Mailing Address
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Address Line | 20851 E RITTENHOUSE RD E103
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-4493
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Country | US
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Telephone | 480-677-2800
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRETT BAKER
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Credential |
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Telephone | 480-707-1398
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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 | 8038
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | AP2911
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License Number State | AZ
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