Organization
KEARNY LIFE CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLENN KEITH AZZARI D.C. (CHIROPRACTOR/PARTNER OWNER)
(520) 363-7734
Entity
Organization
Contact information
Practice address
384 ALDEN RD., KEARNY, AZ 85237
(520) 363-7734
(520) 363-7213
Mailing address
PO BOX 1149, KEARNY, AZ 85237-1149
(520) 363-7734
(520) 363-7213
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
Primary
5499, 5517
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AZ 0935250
BLUE CROSS BLUE SHIELD
AZ
Enumeration date
07/24/2007
Last updated
08/19/2008
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