Provider Demographics
NPI:1730372194
Name:GRAYHAWK FAMILY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:GRAYHAWK FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STATUTORY AGENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:SORRENTINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-247-9063
Mailing Address - Street 1:8714 E VISTA BONITA DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-4249
Mailing Address - Country:US
Mailing Address - Phone:480-247-9063
Mailing Address - Fax:480-247-9974
Practice Address - Street 1:8714 E VISTA BONITA DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-4249
Practice Address - Country:US
Practice Address - Phone:480-247-9063
Practice Address - Fax:480-247-9974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9312PT225100000X
AZ7796111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty