Provider Demographics
NPI:1932948973
Name:EXCELLENT SPIRIT, LLC
Entity type:Organization
Organization Name:EXCELLENT SPIRIT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:480-435-0560
Mailing Address - Street 1:7137 E RANCHO VISTA DR STE B17
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-1781
Mailing Address - Country:US
Mailing Address - Phone:480-435-0560
Mailing Address - Fax:
Practice Address - Street 1:7137 E RANCHO VISTA DR STE B17
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-1781
Practice Address - Country:US
Practice Address - Phone:480-435-0560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-20
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative MedicineGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty