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General NPI Number Information
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NPI Number | 1699015446
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Entity Type | Organization
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Legal Business Name | PODOLAK CHIROPRACTIC CENTER LLC
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Dates
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Enumeration Date | 02/15/2013
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Last Update Date | 02/15/2013
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Provider Practice Location Address
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Address Line | 4131 W THUNDERBIRD RD
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City | PHOENIX
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State | AZ
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Zip | 85053-5341
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Country | US
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Telephone | 602-938-8868
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Fax | 602-938-5084
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Provider Business Mailing Address
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Address Line | 4131 W THUNDERBIRD RD
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City | PHOENIX
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State | AZ
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Zip | 85053-5341
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | TANYA PODOLAK
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Credential | D.C.
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Telephone | 623-687-5428
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 8307
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License Number State | AZ
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