Arizona Sports Clinic LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

ARIZONA SPORTS CLINIC LLC

Practice address

5735 E McKellips Rd
Suite B-106
Mesa, AZ 85215-2875

Phone

(602) 668-8109

NPI assigned

Feb 1, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Tyson Wade Marostica, D.C.

Title

Chiropractor

Phone

(610) 906-6164

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1454284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470009600000",
    "number": "1114385457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5735 E MCKELLIPS RD",
            "address_2": "SUITE B-106",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852152875",
            "telephone_number": "602-668-8109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5735 E MCKELLIPS RD",
            "address_2": "SUITE B-106",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852152875",
            "telephone_number": "602-668-8109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARIZONA SPORTS CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-01",
        "last_updated": "2016-08-01",
        "status": "A",
        "authorized_official_last_name": "MAROSTICA",
        "authorized_official_first_name": "TYSON",
        "authorized_official_middle_name": "WADE",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "610-906-6164",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "AZ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Arizona Vision of Mesa PLC

• Chiropractor in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Chiropractor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2016; 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.