=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467998666
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SIMPLY IN DEMAND CHIROPRACTIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2017
-----------------------------------------------------
Last Update Date | 01/11/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 34406 N 27TH DR BLDG 4 STE 124
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85085-6082
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-635-2820
-----------------------------------------------------
Fax | 800-487-7074
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 34406 N 27TH DR BLDG 4 STE 124
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85085-6082
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR OF CHIROPRACTIC / OWNER
-----------------------------------------------------
Name | KELLI J MEIER
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 602-635-2820
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 8558
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------