MEDICARE: A H CHIROPRACTIC & WELLNESS 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	111NS0005X	Sports Physician Chiropractor	4858	AZ

General Provider Information

NPI Number	:	1306005590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A H CHIROPRACTIC & WELLNESS LLC.

Provider Business Mailing Address
First Line	:	6360 E THOMAS RD STE 218
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-7054
Country	:	US
Telephone Number	:	480-990-9095
Fax Number	:	480-941-1233

Provider Business Practice Location Address
First Line	:	6360 E THOMAS RD STE 218
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-7054
Country	:	US
Telephone Number	:	480-990-9095
Fax Number	:	480-941-1233

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	ROBERT HAINES IVERSEN
Credential	:	D.C.
Telephone Number	:	480-990-9095

Provider Enumeration Date	:	06/03/2008
Last Update Date	:	02/18/2009

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