1376601039 NPI number — MOHAVE CHIROPRACTIC CARE LLC

Table of content: ELAINE D. HILTON RN (NPI 1831466655)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376601039 NPI number — MOHAVE CHIROPRACTIC CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOHAVE CHIROPRACTIC CARE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376601039
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 22698
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BULLHEAD CITY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86439-2698
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-763-9225
Provider Business Mailing Address Fax Number:
928-763-9224

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1708 EL CAZADOR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BULLHEAD CITY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86442-7955
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-763-9225
Provider Business Practice Location Address Fax Number:
928-763-9224
Provider Enumeration Date:
12/05/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JACKSON
Authorized Official First Name:
ALANA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
SOLE MEMBER
Authorized Official Telephone Number:
928-763-9225

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  7139 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P0155410 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 786080 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00100146 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".