Provider Demographics
NPI:1861795056
Name:ENDURANCE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:ENDURANCE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCOTTE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-200-9164
Mailing Address - Street 1:9376 E BAHIA DR
Mailing Address - Street 2:SUITE D103
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-1532
Mailing Address - Country:US
Mailing Address - Phone:480-200-9164
Mailing Address - Fax:
Practice Address - Street 1:9376 E BAHIA DR
Practice Address - Street 2:SUITE D103
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1532
Practice Address - Country:US
Practice Address - Phone:480-200-9164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-10
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7979111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ7979OtherSTATE LICENSE