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General NPI Number Information
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NPI Number | 1255059994
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Entity Type | Organization
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Legal Business Name | EDIFIED CHIROPRACTIC COMPANY LLC
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Dates
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Enumeration Date | 08/18/2022
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Last Update Date | 08/18/2022
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Provider Practice Location Address
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Address Line | 1184 N GILBERT RD STE 200
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City | GILBERT
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State | AZ
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Zip | 85234-2476
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Country | US
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Telephone | 480-903-8008
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Fax |
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Provider Business Mailing Address
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Address Line | 2247 S HARPER
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City | MESA
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State | AZ
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Zip | 85209-2423
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Country | US
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Telephone | 480-903-8008
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TODD BECK
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Credential | DC
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Telephone | 208-680-4246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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