MEDICARE: WRIGHT CHIROPRACTIC 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	261QR0400X	Rehabilitation Clinic/Center	4012	AZ
2	261QM1300X	Multi-Specialty Clinic/Center	7327	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4012	OTHER	AZ	PHYSIOTHERAPY CERTIFICATE
2	7327	OTHER	AZ	CHIROPRACTIC LICENSE
3	AZ0942090	OTHER	AZ	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1396924551
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WRIGHT CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	633 E RAY RD
Second Line	:	STE 110
City	:	GILBERT
State	:	AZ
Zip	:	85296-4202
Country	:	US
Telephone Number	:	480-222-6059
Fax Number	:	480-664-2093

Provider Business Practice Location Address
First Line	:	633 E RAY RD
Second Line	:	STE 110
City	:	GILBERT
State	:	AZ
Zip	:	85296-4202
Country	:	US
Telephone Number	:	480-222-6059
Fax Number	:	480-664-2093

Authorized Official
Title or Position	:	OWNER
Name	:	BRIAN R WRIGHT
Credential	:	DC
Telephone Number	:	480-222-6059

Provider Enumeration Date	:	10/24/2007
Last Update Date	:	01/16/2009

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Directions to “WRIGHT CHIROPRACTIC LLC ” Practice Location

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