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General NPI Number Information
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NPI Number | 1861795056
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Entity Type | Organization
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Legal Business Name | ENDURANCE CHIROPRACTIC LLC
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Dates
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Enumeration Date | 12/10/2010
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Last Update Date | 12/10/2010
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Provider Practice Location Address
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Address Line | 9376 E BAHIA DR SUITE D103
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-1532
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Country | US
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Telephone | 480-200-9164
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Fax |
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Provider Business Mailing Address
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Address Line | 9376 E BAHIA DR SUITE D103
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-1532
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Country | US
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Telephone | 480-200-9164
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | ERIC MARCOTTE
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Credential | DC
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Telephone | 480-200-9164
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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 | 7979
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License Number State | AZ
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