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NPI Code Detail

MEDICARE: DR. MARIO MANUEL PORTILLO DC

MEDICARE: DR. MARIO MANUEL PORTILLO DC
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
1111NR0400XRehabilitation Chiropractor8652AZ
2111N00000XChiropractor8652AZ

General Provider Information

NPI Number : 1770007361
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARIO MANUEL PORTILLO DC
Provider Business Mailing Address
First Line : 1839 S ALMA SCHOOL RD STE 354
Second Line :
City : MESA
State : AZ
Zip : 85210-3028
Country : US
Telephone Number : 480-726-2287
Fax Number : 888-316-9272
Provider Business Practice Location Address
First Line : 20860 N TATUM BLVD STE 290
Second Line :
City : PHOENIX
State : AZ
Zip : 85050-4282
Country : US
Telephone Number : 480-563-1144
Fax Number : 480-563-2371
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2017
Last Update Date : 02/28/2023

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Directions to “ DR. MARIO MANUEL PORTILLO DC” Practice Location

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