Provider Demographics
NPI:1063780708
Name:SUPERSTITION WELLNESS CENTER PLLC
Entity type:Organization
Organization Name:SUPERSTITION WELLNESS CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-857-2098
Mailing Address - Street 1:1100 S DOBSON RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-6157
Mailing Address - Country:US
Mailing Address - Phone:480-857-2098
Mailing Address - Fax:
Practice Address - Street 1:1946 S SIGNAL BUTTE RD
Practice Address - Street 2:SUITE A105
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-2732
Practice Address - Country:US
Practice Address - Phone:480-857-2098
Practice Address - Fax:480-963-7097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty