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General NPI Number Information
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NPI Number | 1114112992
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Entity Type | Organization
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Legal Business Name | DIXIE HEARING AND BALANCE CENTER INC.
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Dates
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Enumeration Date | 09/13/2007
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Last Update Date | 09/13/2007
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Provider Practice Location Address
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Address Line | 1301 BERTHA HOWE AVE STE 6
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City | MESQUITE
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State | NV
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Zip | 89027-7503
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Country | US
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Telephone | 435-688-8991
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Fax | 435-688-2122
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Provider Business Mailing Address
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Address Line | 630 S 400 E STE 103
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City | ST GEORGE
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State | UT
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Zip | 84770-3765
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Country | US
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Telephone | 435-688-8991
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Fax | 435-688-2122
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD LAYNE LUEKENGA JR.
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Credential | AU.D.
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Telephone | 435-688-8991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 59355224101
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License Number State | UT
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