1922298207 NPI number — RED ROCK FAMILY CHIROPRACTIC, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922298207 NPI number — RED ROCK FAMILY CHIROPRACTIC, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RED ROCK FAMILY CHIROPRACTIC, P.C.
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:
1922298207
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
148 3RD AVE SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DICKINSON
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58601-5636
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-586-0574
Provider Business Mailing Address Fax Number:
480-816-4016

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17334 E TEJON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOUNTAIN HILLS
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85268-2665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-586-0574
Provider Business Practice Location Address Fax Number:
480-816-4016
Provider Enumeration Date:
08/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DUKART
Authorized Official First Name:
JESSICA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
480-816-8300

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  5713 , 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)





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