Provider Demographics
NPI:1568632131
Name:ACCELERATED HEALING CLINIC, LLC
Entity type:Organization
Organization Name:ACCELERATED HEALING CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:LERAAEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MUAC
Authorized Official - Phone:602-439-5559
Mailing Address - Street 1:13704 N 51ST AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-1416
Mailing Address - Country:US
Mailing Address - Phone:602-439-5559
Mailing Address - Fax:602-862-9161
Practice Address - Street 1:13704 N 51ST AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-1416
Practice Address - Country:US
Practice Address - Phone:602-439-5559
Practice Address - Fax:602-862-9161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5735111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ72772Medicare PIN