Provider Demographics
NPI:1538267760
Name:CACTUS CHIROPRACTIC CLINIC LLC
Entity type:Organization
Organization Name:CACTUS CHIROPRACTIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEVORE MEEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:623-979-3998
Mailing Address - Street 1:8426 W PEORIA AVE STE B
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345
Mailing Address - Country:US
Mailing Address - Phone:623-979-3998
Mailing Address - Fax:623-878-5976
Practice Address - Street 1:8426 W PEORIA AVE STE B
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345
Practice Address - Country:US
Practice Address - Phone:623-979-3998
Practice Address - Fax:623-878-5976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ100248Medicare ID - Type Unspecified