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General NPI Number Information
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NPI Number | 1659694156
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Entity Type | Organization
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Legal Business Name | ASPEN RAE LLC
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Dates
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Enumeration Date | 03/11/2010
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Last Update Date | 02/02/2011
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Provider Practice Location Address
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Address Line | 21681 N 77TH AVE SUITE 1415
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City | PEORIA
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State | AZ
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Zip | 85382-2132
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Country | US
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Telephone | 623-572-9200
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Fax | 623-572-9204
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Provider Business Mailing Address
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Address Line | 21681 N 77TH AVE SUITE 1415
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City | PEORIA
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State | AZ
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Zip | 85382-2132
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Country | US
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Telephone | 623-572-9200
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Fax | 623-572-9204
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Authorized Official
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Title or Position | OWNER/ DOCTOR
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Name | DR. SHANE ASPEN MCCALL
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Credential | D.C.
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Telephone | 623-572-9200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0000X
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Taxonomy Name | Adolescent Medicine (Family Medicine) Physician
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License Number | 2747
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 7250
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License Number State | AZ
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