MEDICARE: AVONDALE ACCIDENT & PAIN CHIROPRACTIC CENTER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	AZ7287	AZ

General Provider Information

NPI Number	:	1144226747
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVONDALE ACCIDENT & PAIN CHIROPRACTIC CENTER

Provider Business Mailing Address
First Line	:	11335 W BUCKEYE RD
Second Line	:	STE C104
City	:	AVONDALE
State	:	AZ
Zip	:	85323-6814
Country	:	US
Telephone Number	:	623-936-6111
Fax Number	:	623-936-1629

Provider Business Practice Location Address
First Line	:	11335 W BUCKEYE RD
Second Line	:	STE C104
City	:	AVONDALE
State	:	AZ
Zip	:	85323-6814
Country	:	US
Telephone Number	:	623-936-6111
Fax Number	:	623-936-1629

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DR. ROBERTO FERNANDEZ CUNANAN
Credential	:	DC
Telephone Number	:	622-936-6111

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	08/22/2020

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