Organization
CLOUSE CHIROPRACTIC CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUSSELL LEROY CLOUSE DC (PRESIDENT/CEO)
(480) 834-9000
Entity
Organization
Contact information
Practice address
437 S GILBERT RD STE 14, MESA, AZ 85204-2866
(480) 834-9000
(480) 834-1880
Mailing address
437 S GILBERT RD STE 14, MESA, AZ 85204-2866
(480) 834-9000
(480) 834-1880
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
4560
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AZ0943720
BC/BS
AZ
Enumeration date
11/14/2007
Last updated
11/14/2007
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