Provider Demographics
NPI:1487173332
Name:CHIROCADE, INC.
Entity type:Organization
Organization Name:CHIROCADE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:CADE
Authorized Official - Last Name:BRODERICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:520-648-2225
Mailing Address - Street 1:380 W VISTA HERMOSA DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-1901
Mailing Address - Country:US
Mailing Address - Phone:520-648-2225
Mailing Address - Fax:520-625-9777
Practice Address - Street 1:380 W VISTA HERMOSA DR.
Practice Address - Street 2:STE # 100
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614
Practice Address - Country:US
Practice Address - Phone:520-648-2225
Practice Address - Fax:520-625-9777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8231111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty