Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 5738 | AZ |
NPI | 1093778060 |
---|---|
Provider Name | Dr. Patrick Darin Chiavaroli |
First Address | Phoenix, AZ 85032-4805 |
Second Address | Phoenix, AZ 85032-4805 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AZ0245430 | BCBS PROVIDER # (01) | AZ |
U69184 | (02) | AZ |