=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306097225
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | R & R CHIROPRACTIC CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2008
-----------------------------------------------------
Last Update Date | 10/09/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10613 N HAYDEN RD # J108
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85260-5683
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-213-6266
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10613 N HAYDEN RD # J108
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85260-5683
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-213-6266
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. ROBERT ROECK
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 480-213-6266
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------