Provider Demographics
NPI:1063736759
Name:RAINBOW BRIDGE HEALING ARTS CENTER
Entity type:Organization
Organization Name:RAINBOW BRIDGE HEALING ARTS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:520-887-2428
Mailing Address - Street 1:4627 N 1ST AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-8606
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4627 N 1ST AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-8606
Practice Address - Country:US
Practice Address - Phone:520-887-2428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-24
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7607261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service