Provider Demographics
NPI:1427893973
Name:AZANA THERAPEUTIC RECONDITION INC,
Entity type:Organization
Organization Name:AZANA THERAPEUTIC RECONDITION INC,
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:702-300-6014
Mailing Address - Street 1:101 S, RAINBOW BLVD. STE 22
Mailing Address - Street 2:101 S. RAINBOW BLVD. STE # 22
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145
Mailing Address - Country:US
Mailing Address - Phone:702-300-6014
Mailing Address - Fax:
Practice Address - Street 1:101 S, RAINBOW BLVD. STE 22
Practice Address - Street 2:101 S. RAINBOW BLVD. STE # 22
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145
Practice Address - Country:US
Practice Address - Phone:702-300-6014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-26
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty