NPIMap

Organization Active NPI

Country Club Chiropractic LLC

  • Chiropractor
  • Mesa, AZ
National Provider Identifier
1235208265
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
5551 Issued in AZ
Legal business name
COUNTRY CLUB CHIROPRACTIC LLC
Practice address
1140 S Country Club Dr
Suite 111-B
Mesa, AZ 85210-4649
Phone
(480) 834-1700
Fax
(480) 834-1200
NPI assigned
Nov 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Alvin Sanders Sanders, D.C.
Title
Sole Member Practicing Physician
Phone
(480) 834-1700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 5551 AZ Primary

Addresses

Primary practice location

1140 S Country Club Dr
Suite 111-B
Mesa, AZ 85210-4649

Mailing address

1140 S Country Club Dr
Suite 111-B
Mesa, AZ 85210-4649
Phone (480) 834-1700

National Provider Directory

National Provider Directory

Locations

1140 S Country Club Dr
Ste 111B
Mesa, AZ 85210
Phone (480) 834-1700

NPI Registry JSON

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1235208265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1140 S COUNTRY CLUB DR",
            "address_2": "SUITE 111-B",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852104649",
            "telephone_number": "480-834-1700",
            "fax_number": "480-834-1200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1140 S COUNTRY CLUB DR",
            "address_2": "SUITE 111-B",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852104649",
            "telephone_number": "480-834-1700",
            "fax_number": "480-834-1200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY CLUB CHIROPRACTIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SANDERS",
        "authorized_official_first_name": "ALVIN",
        "authorized_official_middle_name": "SANDERS",
        "authorized_official_title_or_position": "SOLE MEMBER PRACTICING PHYSICIAN",
        "authorized_official_telephone_number": "480-834-1700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "AZ",
            "license": "5551",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.