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General NPI Number Information
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NPI Number | 1962581413
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Entity Type | Organization
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Legal Business Name | 5TH STREET ASSOCIATES, INC
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6145 E 5TH ST
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City | TUCSON
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State | AZ
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Zip | 85711-2505
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Country | US
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Telephone | 520-745-1611
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Fax | 520-745-7846
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Provider Business Mailing Address
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Address Line | 6145 E 5TH ST
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City | TUCSON
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State | AZ
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Zip | 85711-2505
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Country | US
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Telephone | 520-745-1611
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Fax | 520-745-7846
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Authorized Official
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Title or Position | OWNER/BOOKKEEPER
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Name | MS. DEBORAH DIANE KELEHER-DICKERSON
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Credential |
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Telephone | 520-745-1611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | 0078522
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License Number State | AZ
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