Provider Demographics
NPI:1174723886
Name:SKYLER BLUE FAMILY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:SKYLER BLUE FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DC
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZZOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:623-907-0454
Mailing Address - Street 1:9550 W VAN BUREN ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-2826
Mailing Address - Country:US
Mailing Address - Phone:623-907-0454
Mailing Address - Fax:623-907-0493
Practice Address - Street 1:9550 W VAN BUREN ST
Practice Address - Street 2:SUITE 10
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-2827
Practice Address - Country:US
Practice Address - Phone:623-907-0454
Practice Address - Fax:623-907-0493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7067261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU97558Medicare UPIN