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General NPI Number Information
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NPI Number | 1689970113
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Entity Type | Organization
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Legal Business Name | PHOENIX FAMILY WELLNESS PLLC
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Dates
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Enumeration Date | 01/31/2011
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Last Update Date | 05/24/2012
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Provider Practice Location Address
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Address Line | 20811 N CAVE CREEK RD #103
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City | PHOENIX
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State | AZ
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Zip | 85024-4461
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Country | US
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Telephone | 602-569-7000
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Fax | 602-569-7001
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Provider Business Mailing Address
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Address Line | 20235 N CAVE CREEK RD #104-459
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City | PHOENIX
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State | AZ
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Zip | 85024-4424
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Country | US
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Telephone | 602-569-7000
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. LORA Y WALFOORT
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Credential | DC
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Telephone | 602-569-7000
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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 | 7909
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License Number State | AZ
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