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General NPI Number Information
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NPI Number | 1598572562
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Entity Type | Organization
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Legal Business Name | MOVE FREE CHIROPRATIC PLLC
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Dates
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Enumeration Date | 12/13/2024
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 3220 E BASELINE RD STE 112
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City | PHOENIX
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State | AZ
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Zip | 85042-7110
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Country | US
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Telephone | 602-437-2225
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Fax |
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Provider Business Mailing Address
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Address Line | 3220 E BASELINE RD STE 112
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City | PHOENIX
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State | AZ
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Zip | 85042-7110
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. MITCHELL GERARD FASSAERT
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Credential | DC
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Telephone | 602-437-2225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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