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General NPI Number Information
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NPI Number | 1649460791
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Entity Type | Organization
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Legal Business Name | CLINICA REAL LLC
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Dates
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Enumeration Date | 07/25/2007
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Last Update Date | 06/23/2010
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Provider Practice Location Address
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Address Line | 1432 N 7TH ST STE 100
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City | PHOENIX
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State | AZ
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Zip | 85006-2524
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Country | US
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Telephone | 602-222-9595
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Fax | 602-234-1211
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Provider Business Mailing Address
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Address Line | 1432 N 7TH ST STE 100
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City | PHOENIX
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State | AZ
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Zip | 85006-2524
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Country | US
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Telephone | 602-222-9595
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Fax | 602-234-1211
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Authorized Official
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Title or Position | OWNER CHIROPRACTOR
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Name | DR. KEITH MICHAEL STONE
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Credential | D.C.
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Telephone | 602-509-5060
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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 | 3458
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License Number State | AZ
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