Healthcare Provider Details

I. General information

NPI: 1235461005
Provider Name (Legal Business Name): DR DAHL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2010
Last Update Date: 02/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3414 W UNION HILLS DR SUITE # 13
PHOENIX AZ
85027-4899
US

IV. Provider business mailing address

3414 W UNION HILLS DR SUITE # 13
PHOENIX AZ
85027-4899
US

V. Phone/Fax

Practice location:
  • Phone: 623-582-6141
  • Fax: 623-581-1924
Mailing address:
  • Phone: 623-582-6141
  • Fax: 623-581-1924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4405
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number124
License Number StateAZ

VIII. Authorized Official

Name: DR. THOMAS EDWARD DAHL
Title or Position: OWNER
Credential: D.C., F.I.A.C.A.
Phone: 623-582-6141