MEDICARE: WARRIOR RESTORATION

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	7207	AZ

General Provider Information

NPI Number	:	1447560933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WARRIOR RESTORATION

Provider Business Mailing Address
First Line	:	4710 N 44TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-3834
Country	:	US
Telephone Number	:	602-840-3430
Fax Number	:	602-522-1800

Provider Business Practice Location Address
First Line	:	4710 N 44TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-3834
Country	:	US
Telephone Number	:	602-840-3430
Fax Number	:	602-522-1800

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	DIANA FELICIANO
Credential	:
Telephone Number	:	480-334-6646

Provider Enumeration Date	:	10/18/2010
Last Update Date	:	10/18/2010

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Directions to “WARRIOR RESTORATION ” Practice Location

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