Provider Demographics
NPI:1093539926
Name:VALHALLA CHIROPRACTIC LLC
Entity type:Organization
Organization Name:VALHALLA CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-202-2749
Mailing Address - Street 1:5345 E MCLELLAN RD UNIT 42
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-3414
Mailing Address - Country:US
Mailing Address - Phone:480-202-2749
Mailing Address - Fax:
Practice Address - Street 1:134 W PEPPER PL
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-7317
Practice Address - Country:US
Practice Address - Phone:602-469-5185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty