Provider Demographics
NPI:1871863639
Name:ORNELAS, WILLIAM PEDROZA (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:PEDROZA
Last Name:ORNELAS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 S 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85701-3111
Mailing Address - Country:US
Mailing Address - Phone:520-622-6765
Mailing Address - Fax:520-791-0237
Practice Address - Street 1:1112 S 5TH AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85701-3111
Practice Address - Country:US
Practice Address - Phone:520-622-6765
Practice Address - Fax:520-791-0237
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDC5353111N00000X
AZ424171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist