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General NPI Number Information
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NPI Number | 1720272172
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Entity Type | Organization
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Legal Business Name | HEALTHSOURCE CHIROPRACTIC LLC ARROWHEAD
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Dates
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Enumeration Date | 08/29/2007
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Last Update Date | 07/19/2012
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Provider Practice Location Address
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Address Line | 8765 W KELTON LN STE 150
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City | PEORIA
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State | AZ
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Zip | 85382-5010
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Country | US
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Telephone | 626-979-7100
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Fax | 623-979-3577
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Provider Business Mailing Address
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Address Line | 8765 W. KELTON LANE SUITE 150
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City | PEORIA
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State | AZ
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Zip | 85382-3802
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Country | US
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Telephone | 623-979-7100
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Fax | 623-979-3577
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Authorized Official
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Title or Position | OWNER
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Name | MRS. DIANA LYNN SRDICH
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Credential |
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Telephone | 623-979-7100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NX0800X
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Taxonomy Name | Orthopedic Chiropractor
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License Number | DC5254
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License Number State | AZ
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