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General NPI Number Information
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NPI Number | 1598961724
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Entity Type | Organization
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Legal Business Name | KEARNY CHIROPRACTIC, LTD.
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Dates
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Enumeration Date | 06/25/2007
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Last Update Date | 02/19/2016
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Provider Practice Location Address
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Address Line | 16846 W. BELL ROAD SUITE 112
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City | SURPIRSE
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State | AZ
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Zip | 85374
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Country | US
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Telephone | 623-556-2335
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Fax | 623-556-9382
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Provider Business Mailing Address
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Address Line | 16846 W. BELL ROAD SUITE 112
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City | SURPIRSE
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State | AZ
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Zip | 85374
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Country | US
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Telephone | 623-556-2335
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Fax | 623-556-9382
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Authorized Official
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Title or Position | OWNER
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Name | BRET A WILSON
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Credential | D.C.
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Telephone | 623-556-2335
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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 | 4307
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License Number State | AZ
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