MEDICARE: MY FAMILY CHIROPRACTOR INC.

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	DC5074	AZ
2	111N00000X	Chiropractor	DC5107	AZ

General Provider Information

NPI Number	:	1316903859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY FAMILY CHIROPRACTOR INC.

Provider Business Mailing Address
First Line	:	11225 N 28TH DR
Second Line	:	A-101
City	:	PHOENIX
State	:	AZ
Zip	:	85029-5606
Country	:	US
Telephone Number	:	602-789-7777
Fax Number	:

Provider Business Practice Location Address
First Line	:	11225 N 28TH DR
Second Line	:	A-101
City	:	PHOENIX
State	:	AZ
Zip	:	85029-5606
Country	:	US
Telephone Number	:	602-789-7777
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KELLY LEVIN
Credential	:	DC
Telephone Number	:	602-789-7777

Provider Enumeration Date	:	04/24/2006
Last Update Date	:	08/22/2020

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Directions to “MY FAMILY CHIROPRACTOR INC. ” Practice Location

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