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NPI Code Detail

MEDICARE: CJK HEALTH CENTER LLC

MEDICARE: CJK HEALTH CENTER 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
1171M00000XCase Manager/Care Coordinator
2363LF0000XFamily Nurse Practitioner

General Provider Information

NPI Number : 1477801173
Entity Type Code : Organization
Provider Name (Legal Business Name) : CJK HEALTH CENTER LLC
Provider Business Mailing Address
First Line : PO BOX 64642
Second Line :
City : PHOENIX
State : AZ
Zip : 85082-4642
Country : US
Telephone Number : 602-889-5833
Fax Number : 602-889-5834
Provider Business Practice Location Address
First Line : 12409 W INDIAN SCHOOL RD STE B210
Second Line :
City : AVONDALE
State : AZ
Zip : 85392-9505
Country : US
Telephone Number : 623-935-9920
Fax Number : 602-889-5834
Authorized Official
Title or Position : OWNER
Name : CHRISTOPHER JOHN KELSCH
Credential : DC
Telephone Number : 623-935-9920
Provider Enumeration Date : 08/28/2012
Last Update Date : 09/10/2012

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