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General NPI Number Information
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NPI Number | 1700061355
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Entity Type | Organization
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Legal Business Name | PHOENIX LIFE CENTER INC
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Dates
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Enumeration Date | 01/02/2008
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Last Update Date | 05/15/2013
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Provider Practice Location Address
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Address Line | 3650 W BETHANY HOME RD
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City | PHOENIX
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State | AZ
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Zip | 85019-1967
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Country | US
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Telephone | 602-973-6609
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Fax | 602-973-0067
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Provider Business Mailing Address
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Address Line | 3650 W BETHANY HOME RD
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City | PHOENIX
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State | AZ
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Zip | 85019-1967
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Country | US
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Telephone | 602-973-6609
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Fax | 602-973-0067
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES M DIANA
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Credential | DC
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Telephone | 602-973-6609
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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 | 875
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License Number State | AZ
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