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General NPI Number Information
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NPI Number | 1932356862
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Entity Type | Organization
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Legal Business Name | 60005 PW HEALTHCARE
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Dates
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Enumeration Date | 08/21/2008
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Last Update Date | 08/26/2008
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Provider Practice Location Address
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Address Line | 3202 E GREENWAY RD STE 1619
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City | PHOENIX
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State | AZ
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Zip | 85032-4553
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Country | US
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Telephone | 602-300-8581
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2954
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City | PHOENIX
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State | AZ
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Zip | 85062-2954
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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 | CHIROPRACTOR
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Name | DR. PIERCE WEST WAYCHOFF
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Credential | D.C.
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Telephone | 602-300-8581
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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 | 7912
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License Number State | AZ
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