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General NPI Number Information
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NPI Number | 1245038702
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Entity Type | Organization
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Legal Business Name | MIND & BODY - CLINICAL & CHIROPRACTIC
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Dates
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Enumeration Date | 03/03/2025
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 5870 W THUNDERBIRD RD STE A7
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City | GLENDALE
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State | AZ
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Zip | 85306-4657
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Country | US
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Telephone | 602-730-2665
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Fax |
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Provider Business Mailing Address
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Address Line | 14786 W ALEXANDRIA WAY
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City | SURPRISE
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State | AZ
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Zip | 85379-4232
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Country | US
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Telephone |
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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 LANGE
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Credential | DC
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Telephone | 623-523-9642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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