MEDICARE: ARIZONA CENTER FOR FUNTIONAL MEDICINE

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		AZ

General Provider Information

NPI Number	:	1821363342
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARIZONA CENTER FOR FUNTIONAL MEDICINE

Provider Business Mailing Address
First Line	:	16421 N TATUM BLVD
Second Line	:	SUITE, 203
City	:	PHOENIX
State	:	AZ
Zip	:	85032-3454
Country	:	US
Telephone Number	:	602-485-8000
Fax Number	:	602-485-8010

Provider Business Practice Location Address
First Line	:	16421 N TATUM BLVD
Second Line	:	SUITE, 203
City	:	PHOENIX
State	:	AZ
Zip	:	85032-3454
Country	:	US
Telephone Number	:	602-485-8000
Fax Number	:	602-485-8010

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MR. PHILLIP JAMES FIERRO
Credential	:	D.C.
Telephone Number	:	602-485-8000

Provider Enumeration Date	:	03/16/2012
Last Update Date	:	03/16/2012

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Directions to “ARIZONA CENTER FOR FUNTIONAL MEDICINE ” Practice Location

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