Provider Demographics
NPI:1962581413
Name:5TH STREET ASSOCIATES, INC
Entity type:Organization
Organization Name:5TH STREET ASSOCIATES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/BOOKKEEPER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:KELEHER-DICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-745-1611
Mailing Address - Street 1:6145 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-2505
Mailing Address - Country:US
Mailing Address - Phone:520-745-1611
Mailing Address - Fax:520-745-7846
Practice Address - Street 1:6145 E 5TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2505
Practice Address - Country:US
Practice Address - Phone:520-745-1611
Practice Address - Fax:520-745-7846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0078522111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZWC28100310OtherWORKERS COMPENSATION
AZAZ0234480OtherBLUE CROSS
AZ3746055OtherACN GROUP
AZ80540Medicare ID - Type UnspecifiedMEDICARE