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General NPI Number Information
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NPI Number | 1295919017
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Entity Type | Organization
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Legal Business Name | ASPEN STAR ENTERPRISES LLC
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Dates
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Enumeration Date | 12/28/2007
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Last Update Date | 02/06/2008
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Provider Practice Location Address
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Address Line | 18472 E WALNUT RD
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City | QUEEN CREEK
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State | AZ
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Zip | 85242-3554
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Country | US
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Telephone | 480-882-3862
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Fax |
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Provider Business Mailing Address
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Address Line | 18521 E QUEEN CREEK RD #105-302
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City | QUEEN CREEK
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State | AZ
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Zip | 85242-5866
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Country | US
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Telephone | 480-882-3862
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TED COFFMAN
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Credential | DC
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Telephone | 480-882-3862
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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 | 853
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License Number State | AZ
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