MEDICARE: CASA GRANDE COMMUNITY ACUPUNCTURE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	171100000X	Acupuncturist
2	225700000X	Massage Therapist
3	363LA2200X	Adult Health Nurse Practitioner
4	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1104513803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASA GRANDE COMMUNITY ACUPUNCTURE LLC

Provider Business Mailing Address
First Line	:	474 N OXFORD LN
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85225-4820
Country	:	US
Telephone Number	:	480-822-8456
Fax Number	:	866-727-9116

Provider Business Practice Location Address
First Line	:	312 W 10TH ST STE 2
Second Line	:
City	:	CASA GRANDE
State	:	AZ
Zip	:	85122-3940
Country	:	US
Telephone Number	:	520-222-7385
Fax Number	:	866-727-9116

Authorized Official
Title or Position	:	OWNER
Name	:	AUBREY EUGENA BACKARIC
Credential	:	DC
Telephone Number	:	520-222-7385

Provider Enumeration Date	:	04/21/2023
Last Update Date	:	07/23/2024

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Directions to “CASA GRANDE COMMUNITY ACUPUNCTURE LLC ” Practice Location

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