Healthcare Provider Details

I. General information

NPI: 1447397336
Provider Name (Legal Business Name): RETAIL AUTOMATION USA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 05/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 S YALE ST SUITE 250
FLAGSTAFF AZ
86001-7304
US

IV. Provider business mailing address

1501 S YALE ST SUITE 250
FLAGSTAFF AZ
86001-7304
US

V. Phone/Fax

Practice location:
  • Phone: 928-556-0707
  • Fax: 928-779-2223
Mailing address:
  • Phone: 928-556-0707
  • Fax: 928-779-2223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5935
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number1058
License Number StateAZ

VIII. Authorized Official

Name: MR. MARK LOVE
Title or Position: CEO
Credential:
Phone: 928-556-0707