Provider Demographics
NPI:1144304627
Name:LORD CHIROPRACTIC CENTER LTD
Entity type:Organization
Organization Name:LORD CHIROPRACTIC CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:ALICE
Authorized Official - Last Name:LORD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:623-939-8325
Mailing Address - Street 1:5041 W NORTHERN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-1539
Mailing Address - Country:US
Mailing Address - Phone:623-939-8325
Mailing Address - Fax:
Practice Address - Street 1:5041 W NORTHERN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-1539
Practice Address - Country:US
Practice Address - Phone:623-939-8325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ416111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
392305108Medicare ID - Type Unspecified