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General NPI Number Information
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NPI Number | 1992997472
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Entity Type | Organization
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Legal Business Name | ARIZONA FITNESS CHIROPRACTIC LLC
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Dates
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Enumeration Date | 08/17/2007
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Last Update Date | 09/11/2007
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Provider Practice Location Address
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Address Line | 5536 W BELL RD
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City | GLENDALE
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State | AZ
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Zip | 85308-3866
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Country | US
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Telephone | 602-863-9111
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Fax | 602-863-3633
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Provider Business Mailing Address
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Address Line | PO BOX 12585
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City | GLENDALE
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State | AZ
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Zip | 85318-2585
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Country | US
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Telephone | 602-863-9111
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Fax | 602-863-3633
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. WAYNE A HARMON
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Credential | D.C.
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Telephone | 602-863-9111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | D.C. 5922, PHYSIOTHE
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License Number State | AZ
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