Healthcare Provider Details

I. General information

NPI: 1972865939
Provider Name (Legal Business Name): BEELINE CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2012
Last Update Date: 06/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 S BEELINE HWY SUITE 6
PAYSON AZ
85541-4884
US

IV. Provider business mailing address

414 S BEELINE HWY SUITE 6
PAYSON AZ
85541-4884
US

V. Phone/Fax

Practice location:
  • Phone: 928-474-5555
  • Fax: 928-474-3707
Mailing address:
  • Phone: 928-474-5555
  • Fax: 928-474-3707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3547
License Number StateAZ

VIII. Authorized Official

Name: ROBERT JON SANDERS
Title or Position: PRESIDENT
Credential: D.C.
Phone: 928-474-5555