Organization
DESERT RIDGE SPINE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TOM OHARA D.C. (PRESIDENT)
(480) 832-3318
Entity
Organization
Contact information
Practice address
3035 S ELLSWORTH RD, SUITE 109, MESA, AZ 85212-2160
(480) 832-3318
(480) 621-7208
Mailing address
3035 S ELLSWORTH RD, SUITE 109, MESA, AZ 85212-2160
(480) 832-3318
(480) 621-7208
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
DC4914
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AZ0236730
BLUE CROSS
AZ
Enumeration date
03/01/2007
Last updated
10/09/2007
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