Provider Demographics
NPI:1316234339
Name:ADJUSTED 4 LIFE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:ADJUSTED 4 LIFE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:T
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-802-9977
Mailing Address - Street 1:3210 SOUTH GILBERT ROAD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286
Mailing Address - Country:UM
Mailing Address - Phone:480-802-9977
Mailing Address - Fax:480-802-9944
Practice Address - Street 1:3210 S GILBERT RD
Practice Address - Street 2:SUITE 1
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-5108
Practice Address - Country:US
Practice Address - Phone:480-802-9977
Practice Address - Fax:480-802-9944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-29
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7848111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty