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General NPI Number Information
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NPI Number | 1730372194
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Entity Type | Organization
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Legal Business Name | GRAYHAWK FAMILY CHIROPRACTIC LLC
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Dates
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Enumeration Date | 08/20/2007
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Last Update Date | 04/17/2017
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Provider Practice Location Address
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Address Line | 8714 E VISTA BONITA DR SUITE 101
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City | SCOTTSDALE
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State | AZ
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Zip | 85255-4249
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Country | US
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Telephone | 480-247-9063
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Fax | 480-247-9974
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Provider Business Mailing Address
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Address Line | 8714 E VISTA BONITA DR SUITE 101
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City | SCOTTSDALE
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State | AZ
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Zip | 85255-4249
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Country | US
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Telephone | 480-247-9063
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Fax | 480-247-9974
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Authorized Official
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Title or Position | STATUTORY AGENT
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Name | DR. FRANK SORRENTINO
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Credential | D.C.
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Telephone | 480-247-9063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 9312PT
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 7796
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License Number State | AZ
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