MEDICARE: COMBS SURPRISE CROSSING, LLC

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	4793	AZ

General Provider Information

NPI Number	:	1225217110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMBS SURPRISE CROSSING, LLC

Provider Business Mailing Address
First Line	:	13794 W WADDELL RD
Second Line	:	SUITE 205
City	:	SURPRISE
State	:	AZ
Zip	:	85379-8499
Country	:	US
Telephone Number	:	623-584-7756
Fax Number	:

Provider Business Practice Location Address
First Line	:	13794 W WADDELL RD
Second Line	:	SUITE 205
City	:	SURPRISE
State	:	AZ
Zip	:	85379-8499
Country	:	US
Telephone Number	:	623-584-7756
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	ROGER E COMBS
Credential	:	D.C.
Telephone Number	:	623-584-7756

Provider Enumeration Date	:	10/29/2007
Last Update Date	:	10/29/2007

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