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General NPI Number Information
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NPI Number | 1194959494
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Entity Type | Organization
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Legal Business Name | SHELL CHIROPRACTIC, INC
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Dates
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Enumeration Date | 05/14/2009
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Last Update Date | 05/14/2009
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Provider Practice Location Address
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Address Line | 114 W ADAMS ST C-105
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City | PHOENIX
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State | AZ
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Zip | 85003-2000
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Country | US
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Telephone | 602-254-0177
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Fax | 602-252-3153
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Provider Business Mailing Address
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Address Line | PO BOX 5659
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City | SCOTTSDALE
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State | AZ
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Zip | 85261-5659
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Country | US
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Telephone | 602-254-0177
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Fax | 602-252-3153
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Authorized Official
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Title or Position | OWNER
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Name | DR. BARBARA ROGNE
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Credential | D.C.
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Telephone | 602-254-0177
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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 | 4887
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License Number State | AZ
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