MEDICARE: QUALLS COMPREHENSIVE CHIROPRACTIC 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	2030	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AZ0938530	OTHER	AZ	BCBS

General Provider Information

NPI Number	:	1528256310
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALLS COMPREHENSIVE CHIROPRACTIC INC

Provider Business Mailing Address
First Line	:	12020 N 35TH AVE
Second Line	:	STE 102
City	:	PHOENIX
State	:	AZ
Zip	:	85029-3213
Country	:	US
Telephone Number	:	602-862-9419
Fax Number	:	866-905-5721

Provider Business Practice Location Address
First Line	:	12020 N 35TH AVE
Second Line	:	STE 102
City	:	PHOENIX
State	:	AZ
Zip	:	85029-3213
Country	:	US
Telephone Number	:	602-862-9419
Fax Number	:	866-905-5721

Authorized Official
Title or Position	:	OWNER
Name	:	RICHARD A QUALLS JR.
Credential	:	DC
Telephone Number	:	602-862-9419

Provider Enumeration Date	:	10/05/2007
Last Update Date	:	10/05/2007

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