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General NPI Number Information
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NPI Number | 1851317259
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Entity Type | Organization
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Legal Business Name | DR. SERGIO NINO LIFE CHIROPRACTIC
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 01/26/2015
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Provider Practice Location Address
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Address Line | 2333 W NORTHERN AVE STE 1B
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City | PHOENIX
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State | AZ
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Zip | 85021-9348
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Country | US
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Telephone | 602-995-4336
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Fax | 602-995-4340
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Provider Business Mailing Address
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Address Line | 2333 W NORTHERN AVE STE 1B
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City | PHOENIX
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State | AZ
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Zip | 85021-9348
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Country | US
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Telephone | 602-995-4336
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Fax | 602-995-4340
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | DR. SERGIO NINO
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Credential | D.C.
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Telephone | 602-995-4336
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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 | 8019
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License Number State | AZ
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