Provider Demographics
NPI:1972714368
Name:OCOTILLO CHIROPRACTIC CENTER II PC
Entity type:Organization
Organization Name:OCOTILLO CHIROPRACTIC CENTER II PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-940-1991
Mailing Address - Street 1:1880 S ALMA SCHOOL RD
Mailing Address - Street 2:STE 1
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-2074
Mailing Address - Country:US
Mailing Address - Phone:480-963-2772
Mailing Address - Fax:480-963-3572
Practice Address - Street 1:1075 E RIGGS RD
Practice Address - Street 2:STE 1
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-3685
Practice Address - Country:US
Practice Address - Phone:480-940-1991
Practice Address - Fax:480-802-1912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty