60002 Avondale Rehabilitation Center

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

7536 Issued in AZ

Legal business name

60002 AVONDALE REHABILITATION CENTER

Practice address

12409 W Indian School Rd
B210
Avondale, AZ 85392-9502

Phone

(623) 935-9920

NPI assigned

Aug 25, 2008

Last updated

Aug 29, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Krista Marie Gerau, DC

Title

Owner

Phone

(623) 935-9920

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1219622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219968000000",
    "number": "1700033412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2954",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850822954",
            "telephone_number": "623-935-9920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12409 W INDIAN SCHOOL RD",
            "address_2": "B210",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853929502",
            "telephone_number": "623-935-9920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "60002 AVONDALE REHABILITATION CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-25",
        "last_updated": "2008-08-29",
        "status": "A",
        "authorized_official_last_name": "GERAU",
        "authorized_official_first_name": "KRISTA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "623-935-9920",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "AZ",
            "license": "7536",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2008; 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.