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General NPI Number Information
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NPI Number | 1770735656
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Entity Type | Organization
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Legal Business Name | TOTAL LIFESTYLE CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 10/22/2008
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Last Update Date | 09/13/2012
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Provider Practice Location Address
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Address Line | 7032 E COCHISE RD STE A130
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City | SCOTTSDALE
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State | AZ
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Zip | 85253-4546
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Country | US
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Telephone | 480-368-2639
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Fax | 480-368-2643
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Provider Business Mailing Address
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Address Line | 7032 E COCHISE RD STE A130
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City | SCOTTSDALE
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State | AZ
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Zip | 85253-4546
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Country | US
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Telephone | 480-368-2639
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Fax | 480-368-2643
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Authorized Official
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Title or Position | OWNER/ CHIROPRACTOR
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Name | MS. SONYA ANN BLADOW
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Credential | D.C.
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Telephone | 480-368-2639
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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 | 7965
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License Number State | AZ
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