| Aspen Rae Llc | |
|
21681 N 77th Ave Suite 1415 Peoria AZ 85382-2132 | |
| (623) 572-9200 | |
| (623) 572-9204 |
| Full Name | Aspen Rae Llc |
|---|---|
| Speciality | Chiropractor |
| Location | 21681 N 77th Ave, Peoria, Arizona |
| Authorized Official Name and Position | Shane Aspen Mccall (OWNER/ DOCTOR) |
| Authorized Official Contact | 6235729200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Aspen Rae Llc 21681 N 77th Ave Suite 1415 Peoria AZ 85382-2132 Ph: (623) 572-9200 | Aspen Rae Llc 21681 N 77th Ave Suite 1415 Peoria AZ 85382-2132 Ph: (623) 572-9200 |
| NPI Number | 1659694156 |
|---|---|
| Provider Enumeration Date | 03/11/2010 |
| Last Update Date | 02/02/2011 |
| Medicare PECOS PAC ID | 2062548472 |
|---|---|
| Medicare Enrollment ID | O20100324001006 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659694156 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0000X | Family Medicine - Adolescent Medicine | 2747 (Arizona) | Secondary |
| 111NR0400X | Chiropractor - Rehabilitation | 7250 (Arizona) | Primary |
| Provider Name | Shane A Mccall |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1912933227 PECOS PAC ID: 5991805798 Enrollment ID: I20070710000042 |
| Provider Name | Bryan R Glick |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164620308 PECOS PAC ID: 2365624137 Enrollment ID: I20110315001022 |
| Provider Name | Joseph Jean Vigneau |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1750636007 PECOS PAC ID: 1456503309 Enrollment ID: I20210615000718 |
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