MEDICARE: KAI-ZEN WELLNESS 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	111N00000X	Chiropractor	8005	AZ

General Provider Information

NPI Number	:	1811137409
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAI-ZEN WELLNESS LLC

Provider Business Mailing Address
First Line	:	15300 N 90TH ST
Second Line	:	SUITE 950
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85260-2771
Country	:	US
Telephone Number	:	480-941-2147
Fax Number	:	480-941-2157

Provider Business Practice Location Address
First Line	:	15300 N 90TH ST
Second Line	:	SUITE 950
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85260-2771
Country	:	US
Telephone Number	:	480-941-2147
Fax Number	:	480-941-2157

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	DR. STEPHEN MICHAEL HRUBY
Credential	:	D.C.
Telephone Number	:	480-203-3998

Provider Enumeration Date	:	02/23/2009
Last Update Date	:	03/30/2016

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