Provider Demographics
NPI:1104937838
Name:CHIROPRACTIC WORKS WEST
Entity type:Organization
Organization Name:CHIROPRACTIC WORKS WEST
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:J
Authorized Official - Last Name:HILLENBRAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-284-9072
Mailing Address - Street 1:854 RAVINE TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-2721
Mailing Address - Country:US
Mailing Address - Phone:480-284-9072
Mailing Address - Fax:
Practice Address - Street 1:2515 N SCOTTSDALE RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-1352
Practice Address - Country:US
Practice Address - Phone:480-284-9072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3629111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1518967298OtherBCBS
MI142906521Medicaid
MI95-0-F3-2959-0OtherBCBS
MI950F317350OtherBCBSM
MI950F317350OtherBCBSM