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Organization
HEALTHSOURCE CHIROPRACTIC LLC ARROWHEAD
Active
Organization
HEALTHSOURCE CHIROPRACTIC LLC ARROWHEAD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DIANA LYNN SRDICH (OWNER)
(623) 979-7100
Entity
Organization
Contact information
Practice address
8765 W KELTON LN STE 150, PEORIA, AZ 85382-5010
(626) 979-7100
(623) 979-3577
Mailing address
8765 W. KELTON LANE SUITE 150, PEORIA, AZ 85382-3802
(623) 979-7100
(623) 979-3577
Taxonomy
Speciality
Code
Description
License number
State
111NX0800X
Orthopedic Chiropractor
Primary
DC5254
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1346320736
BLUE CROSS/ BLUE SHIELD
AZ
01
—
1Z4643
HEALTHNET
AZ
01
—
P00219760
RAILROAD M/C
AZ
Enumeration date
08/29/2007
Last updated
07/19/2012
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