Provider Demographics
NPI:1053542175
Name:ARIZONA WELLNESS CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:ARIZONA WELLNESS CHIROPRACTIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHETT
Authorized Official - Middle Name:L
Authorized Official - Last Name:MALLETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:602-298-8400
Mailing Address - Street 1:13934 N 59TH AVE
Mailing Address - Street 2:100
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4167
Mailing Address - Country:US
Mailing Address - Phone:602-298-8400
Mailing Address - Fax:
Practice Address - Street 1:13934 N 59TH AVE
Practice Address - Street 2:100
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4167
Practice Address - Country:US
Practice Address - Phone:602-298-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty