=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053486506
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | R.M. DAHL CHIROPRACTIC & FUNCTIONAL MEDICINE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2622 N STEVES BLVD
-----------------------------------------------------
City | FLAGSTAFF
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86004-3938
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-226-7191
-----------------------------------------------------
Fax | 928-526-5767
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2622 N STEVES BLVD
-----------------------------------------------------
City | FLAGSTAFF
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86004-3938
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-226-7191
-----------------------------------------------------
Fax | 928-526-5767
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | DR. ROBERT MICHAEL DAHL
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 928-226-7191
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 5436
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------