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General NPI Number Information
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NPI Number | 1912101924
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Entity Type | Organization
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Legal Business Name | DE BRUIN CHIROPRACTIC LTD
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 8010 E MCDOWELL RD STE 123
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City | SCOTTSDALE
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State | AZ
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Zip | 85257-3869
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Country | US
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Telephone | 480-946-4476
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Fax |
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Provider Business Mailing Address
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Address Line | 8010 E MCDOWELL RD STE 123
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City | SCOTTSDALE
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State | AZ
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Zip | 85257-3869
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOSEPH DE BRUIN
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Credential |
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Telephone | 480-946-4476
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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 | 04559
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License Number State | AZ
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