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General NPI Number Information
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NPI Number | 1356673800
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Entity Type | Organization
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Legal Business Name | QUEEN CREEK BACK CARE, LLC
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Dates
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Enumeration Date | 02/09/2010
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Last Update Date | 02/09/2010
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Provider Practice Location Address
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Address Line | 20231 E OCOTILLO RD SUITE 1
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-7639
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Country | US
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Telephone | 480-677-3900
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Fax | 480-677-8310
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Provider Business Mailing Address
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Address Line | 20231 E OCOTILLO RD SUITE 1
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-7639
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Country | US
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Telephone | 480-677-3900
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Fax | 480-677-8310
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Authorized Official
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Title or Position | OWNER
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Name | WAYNE CHRISTENSEN
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Credential | DC
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Telephone | 480-241-1611
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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 | 5944
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License Number State | AZ
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