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General NPI Number Information
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NPI Number | 1467780197
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Entity Type | Organization
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Legal Business Name | BACK HEALTH CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 11/18/2009
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Last Update Date | 11/18/2009
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Provider Practice Location Address
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Address Line | 4503 N 32ND ST
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City | PHOENIX
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State | AZ
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Zip | 85018-3339
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Country | US
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Telephone | 602-956-8222
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Fax | 602-956-8333
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Provider Business Mailing Address
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Address Line | 4503 N 32ND ST
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City | PHOENIX
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State | AZ
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Zip | 85018-3339
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Country | US
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Telephone | 602-956-8222
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Fax | 602-956-8333
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | GOUDARZ VASSIGH
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Credential | D.C.
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Telephone | 602-956-8222
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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 | 5608
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License Number State | AZ
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