=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720404544
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GENTLE TOUCH HEADACHE & SPINE CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2014
-----------------------------------------------------
Last Update Date | 03/17/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4515 N 32ND ST STE 110
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85018-3354
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-552-3292
-----------------------------------------------------
Fax | 623-552-3294
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4515 N 32ND ST STE 110
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85018-3354
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-552-3292
-----------------------------------------------------
Fax | 623-552-3294
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR OF CHIROPRACTIC/PRESIDENT
-----------------------------------------------------
Name | DR. AARON F TROMBETTA
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 623-552-3292
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 8271
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 8031
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------