Provider Demographics
NPI:1497626287
Name:CASTRICHINI, EMILLIE ROSE
Entity type:Individual
Prefix:
First Name:EMILLIE
Middle Name:ROSE
Last Name:CASTRICHINI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 E ROADRUNNER RD
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-3330
Mailing Address - Country:US
Mailing Address - Phone:602-956-0111
Mailing Address - Fax:
Practice Address - Street 1:4619 N 24TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-5203
Practice Address - Country:US
Practice Address - Phone:602-956-0111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9491111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty