Provider Demographics
NPI:1104513803
Name:CASA GRANDE COMMUNITY ACUPUNCTURE LLC
Entity type:Organization
Organization Name:CASA GRANDE COMMUNITY ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUBREY
Authorized Official - Middle Name:EUGENA
Authorized Official - Last Name:BACKARIC
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:520-222-7385
Mailing Address - Street 1:474 N OXFORD LN
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-4820
Mailing Address - Country:US
Mailing Address - Phone:480-822-8456
Mailing Address - Fax:866-727-9116
Practice Address - Street 1:312 W 10TH ST STE 2
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-3940
Practice Address - Country:US
Practice Address - Phone:520-222-7385
Practice Address - Fax:866-727-9116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-21
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty