Provider Demographics
NPI:1316135551
Name:SPORTS & FAM CARE CLINIC INC
Entity type:Organization
Organization Name:SPORTS & FAM CARE CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-704-6133
Mailing Address - Street 1:16515 S 40TH ST
Mailing Address - Street 2:SUITE 133
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-0558
Mailing Address - Country:US
Mailing Address - Phone:480-704-6133
Mailing Address - Fax:480-704-5874
Practice Address - Street 1:16515 S 40TH ST
Practice Address - Street 2:SUITE 133
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-0558
Practice Address - Country:US
Practice Address - Phone:480-704-6133
Practice Address - Fax:480-704-5874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5932111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ78244Medicare PIN