Provider Demographics
NPI:1265592489
Name:K & Q ALLIED CHIROPRACTIC INC.
Entity type:Organization
Organization Name:K & Q ALLIED CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:KEMLAGE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:623-972-2258
Mailing Address - Street 1:10404 W COGGINS DR STE 114
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3465
Mailing Address - Country:US
Mailing Address - Phone:623-972-2258
Mailing Address - Fax:623-875-8020
Practice Address - Street 1:10404 W COGGINS DR STE 114
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3465
Practice Address - Country:US
Practice Address - Phone:623-972-2258
Practice Address - Fax:623-875-8020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5445111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0005136133OtherAETNA
AZAZ-0248910OtherBLUE CROSS BLUE SHIELD
AZ=========OtherTAX IDENTIFICATION NUMBER
AZ0005136133OtherAETNA