NPIMap

Organization Active NPI

Triad Chiropractic & Rehabilitation Clinics, LLC

  • Independent Medical Examiner Chiropractor
  • Tempe, AZ
National Provider Identifier
1326362807
Registry record updated Dec 4, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Independent Medical Examiner ChiropractorTaxonomy code 111NI0013X
License
AZ5837 Issued in AZ
Legal business name
TRIAD CHIROPRACTIC & REHABILITATION CLINICS, LLC
Practice address
4515 S. McClintock Drive
Suite 120
Tempe, AZ 85282-7382
Phone
(480) 413-0586
Fax
(480) 413-0586
NPI assigned
Mar 26, 2010
Last updated
Dec 4, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2017

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

Authorized official

Name
Dr. John J Baca, DCNPI 1013975200
Title
Owner/Physician
Phone
(480) 413-0586

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Independent Medical Examiner Chiropractor 111NI0013X 5837 AZ
Independent Medical Examiner Chiropractor 111NI0013X AZ5837 AZ Primary

Addresses

Primary practice location

4515 S. McClintock Drive
Suite 120
Tempe, AZ 85282-7382

Mailing address

2745 S Alma School Rd Ste 2
Chandler, AZ 85286-4405
Phone (480) 413-0586

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100508000147 AZ Part B Supplier - Clinic/Group Practice 2163550351 Receives reassigned benefits from 8 practitioners
Practice locations: Gold Canyon, AZ

National Provider Directory

National Provider Directory

Locations

5331 S Superstition Mountain Dr
#C105
Queen Valley, AZ 85118
Phone (480) 413-0586

4515 S McClintock Dr
Ste 120
Tempe, AZ 85282
Phone (480) 413-0586

Practitioners & affiliated clinicians

Practitioners 20

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.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1269561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512345600000",
    "number": "1326362807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2745 S ALMA SCHOOL RD STE 2",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852864405",
            "telephone_number": "480-413-0586",
            "fax_number": "480-730-0487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4515 S. MCCLINTOCK DRIVE",
            "address_2": "SUITE 120",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852827382",
            "telephone_number": "480-413-0586",
            "fax_number": "480-413-0586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRIAD CHIROPRACTIC & REHABILITATION CLINICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-26",
        "last_updated": "2017-12-04",
        "status": "A",
        "authorized_official_last_name": "BACA",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "480-413-0586",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111NI0013X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Independent Medical Examiner",
            "state": "AZ",
            "license": "5837",
            "primary": false
        },
        {
            "code": "111NI0013X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Independent Medical Examiner",
            "state": "AZ",
            "license": "AZ5837",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tempe, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.