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General NPI Number Information
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NPI Number | 1568737377
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Entity Type | Organization
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Legal Business Name | RALLY FOR ROUND TWO PLLC
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Dates
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Enumeration Date | 03/12/2012
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Last Update Date | 06/05/2012
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Provider Practice Location Address
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Address Line | 21050 N TATUM BLVD SUITE 114
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City | PHOENIX
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State | AZ
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Zip | 85050-4260
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Country | US
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Telephone | 480-585-7463
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Fax |
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Provider Business Mailing Address
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Address Line | 21050 N TATUM BLVD SUITE 114
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City | PHOENIX
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State | AZ
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Zip | 85050-4260
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Country | US
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Telephone | 480-585-7463
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Fax |
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Authorized Official
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Title or Position | OWNER DOCTOR
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Name | DR. AARON LAWRENCE WIEGAND
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Credential | DC
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Telephone | 602-377-3122
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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 | 7804
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License Number State | AZ
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