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General NPI Number Information
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NPI Number | 1609576123
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Entity Type | Organization
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Legal Business Name | KICK START INTEGRATIVE HEALTH PLLC
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Dates
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Enumeration Date | 03/03/2023
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Last Update Date | 06/02/2023
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Provider Practice Location Address
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Address Line | 6320 W UNION HILLS DR STE B1500
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City | GLENDALE
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State | AZ
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Zip | 85308-1062
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Country | US
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Telephone | 623-776-6633
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Fax | 602-428-6860
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Provider Business Mailing Address
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Address Line | 6320 W UNION HILLS DR STE B1500
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City | GLENDALE
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State | AZ
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Zip | 85308-1062
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Country | US
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Telephone | 623-776-6633
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Fax | 602-428-6860
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | ANDREW B ANTHONY
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Credential | D.C., FNP-C
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Telephone | 623-776-6633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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