NPIMap

Organization Active NPI

Bridge Wellness Center LLC

  • Chiropractor
  • Phoenix, AZ
National Provider Identifier
1043925688
Registry record updated Jan 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
BRIDGE WELLNESS CENTER LLC
Practice address
4645 E Chandler Blvd Ste 100
Phoenix, AZ 85048-0432
Phone
(724) 681-4915
NPI assigned
Jan 18, 2023
Last updated
Jan 18, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Matthew McCutcheon, DCNPI 1437864071
Title
Ao/Provider/Owner
Phone
(724) 681-4915

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X NU Primary
Occupational Therapist 225X00000X NU
Pediatric Occupational Therapist 225XP0200X NU

Addresses

Primary practice location

4645 E Chandler Blvd Ste 100
Phoenix, AZ 85048-0432

Mailing address

4645 E Chandler Blvd Ste 100
Phoenix, AZ 85048-0432
Phone (724) 681-4915

National Provider Directory

National Provider Directory

Locations

4645 E Chandler Blvd
Ste 100
Phoenix, AZ 85048
Phone (515) 306-7215

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1674000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674000000000",
    "number": "1043925688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4645 E CHANDLER BLVD STE 100",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850480432",
            "telephone_number": "724-681-4915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4645 E CHANDLER BLVD STE 100",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850480432",
            "telephone_number": "724-681-4915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGE WELLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-18",
        "last_updated": "2023-01-18",
        "certification_date": "2023-01-18",
        "status": "A",
        "authorized_official_last_name": "MCCUTCHEON",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "AO/PROVIDER/OWNER",
        "authorized_official_telephone_number": "724-681-4915",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.