Formation Chiropractic, LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

FORMATION CHIROPRACTIC, LLC

Practice address

3632 E Indian School Rd
Phoenix, AZ 85018-5127

Phone

(480) 717-9577

NPI assigned

Oct 31, 2019

Organization subpart

No

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

Authorized official

Name

Colby Giles, DC

Title

Owner

Phone

(480) 717-9577

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1572480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572480000000",
    "number": "1073157178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3632 E INDIAN SCHOOL RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850185127",
            "telephone_number": "480-717-9577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3632 E INDIAN SCHOOL RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850185127",
            "telephone_number": "480-717-9577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORMATION CHIROPRACTIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-31",
        "last_updated": "2019-10-31",
        "status": "A",
        "authorized_official_last_name": "GILES",
        "authorized_official_first_name": "COLBY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-717-9577",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Russell Fornator, CCP
• Colleen Lynn Fornear, PMHNP- BC
• Lucas Christien Fornefeld
• Ryan James Forney, MD
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• Chiropractor in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Chiropractor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2019; 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.