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General NPI Number Information
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NPI Number | 1275719676
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Entity Type | Organization
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Legal Business Name | ULTIMATE HEALTH CLINIC, LLC
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Dates
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Enumeration Date | 01/15/2008
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Last Update Date | 01/15/2008
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Provider Practice Location Address
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Address Line | 13065 W MCDOWELL RD SUITE B-111
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City | AVONDALE
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State | AZ
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Zip | 85392-6439
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Country | US
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Telephone | 623-374-3200
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Fax | 623-388-3469
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Provider Business Mailing Address
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Address Line | 13065 W MCDOWELL RD SUITE B-111
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City | AVONDALE
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State | AZ
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Zip | 85392-6439
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Country | US
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Telephone | 623-374-3200
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Fax | 623-388-3469
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Authorized Official
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Title or Position | CEO
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Name | DR. STEVEN G HIGGINS
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Credential | D.C.
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Telephone | 623-374-3200
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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 | 7411
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License Number State | AZ
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