NPIMap

Organization Active NPI

Healthsource Chiropractic LLC Arrowhead

  • Orthopedic Chiropractor
  • Peoria, AZ
National Provider Identifier
1720272172
Registry record updated Jul 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic ChiropractorTaxonomy code 111NX0800X
License
DC5254 Issued in AZ
Legal business name
HEALTHSOURCE CHIROPRACTIC LLC ARROWHEAD
Practice address
8765 W Kelton LN Ste 150
Peoria, AZ 85382-5010
Phone
(626) 979-7100
Fax
(623) 979-3577
NPI assigned
Aug 29, 2007
Last updated
Jul 19, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2012

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

Authorized official

Name
Mrs. Diana Lynn SrdichNPI 1346320736
Title
Owner
Phone
(623) 979-7100

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111NX0800X DC5254 AZ Primary

Addresses

Primary practice location

8765 W Kelton LN Ste 150
Peoria, AZ 85382-5010

Mailing address

8765 W. Kelton Lane Suite 150
Peoria, AZ 85382-3802
Phone (623) 979-7100

Other identifiers 3

IdentifierTypeStateIssuer
1346320736OtherAZBLUE CROSS/ BLUE SHIELD
1Z4643OtherAZHEALTHNET
P00219760OtherAZRAILROAD M/C

National Provider Directory

National Provider Directory

Locations

8765 W Kelton Ln
#B4150
Peoria, AZ 85382
Phone (623) 979-7100

7789 W Bell Rd
Ste 101
Peoria, AZ 85382
Phone (602) 979-7100

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1188345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342656000000",
    "number": "1720272172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8765 W. KELTON LANE SUITE 150",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853823802",
            "telephone_number": "623-979-7100",
            "fax_number": "623-979-3577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8765 W KELTON LN STE 150",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853825010",
            "telephone_number": "626-979-7100",
            "fax_number": "623-979-3577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHSOURCE CHIROPRACTIC LLC ARROWHEAD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-29",
        "last_updated": "2012-07-19",
        "status": "A",
        "authorized_official_last_name": "SRDICH",
        "authorized_official_first_name": "DIANA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "623-979-7100",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "111NX0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor, Orthopedic",
            "state": "AZ",
            "license": "DC5254",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/ BLUE SHIELD",
            "identifier": "1346320736",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "1Z4643",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD M/C",
            "identifier": "P00219760",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2012; 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.