Provider Demographics
NPI:1992997472
Name:ARIZONA FITNESS CHIROPRACTIC LLC
Entity type:Organization
Organization Name:ARIZONA FITNESS CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HARMON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:602-863-9111
Mailing Address - Street 1:PO BOX 12585
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85318-2585
Mailing Address - Country:US
Mailing Address - Phone:602-863-9111
Mailing Address - Fax:602-863-3633
Practice Address - Street 1:5536 W BELL RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3866
Practice Address - Country:US
Practice Address - Phone:602-863-9111
Practice Address - Fax:602-863-3633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD.C. 5922, PHYSIOTHE111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ64582Medicare PIN