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General NPI Number Information
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NPI Number | 1770765562
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Entity Type | Organization
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Legal Business Name | SECREST FAMILY CHIROPRACTIC, PC
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Dates
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Enumeration Date | 12/04/2007
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Last Update Date | 12/04/2007
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Provider Practice Location Address
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Address Line | 3350 N HAYDEN RD SUITE 112
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-6685
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Country | US
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Telephone | 480-994-4411
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Fax | 480-994-4421
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Provider Business Mailing Address
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Address Line | 3350 N HAYDEN RD SUITE 112
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-6685
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Country | US
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Telephone | 480-994-4411
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Fax | 480-994-4421
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DANIEL PAUL SECREST
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Credential | DC
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Telephone | 480-994-4411
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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 | 7326
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License Number State | AZ
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