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General NPI Number Information
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NPI Number | 1336192871
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Entity Type | Organization
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Legal Business Name | KACHINA HEALING CENTER, LLC
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 05/22/2012
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Provider Practice Location Address
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Address Line | 8363 E FLORENTINE RD SUITE C
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-4971
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Country | US
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Telephone | 928-772-4500
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Fax | 928-772-2622
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Provider Business Mailing Address
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Address Line | 8363 E FLORENTINE RD SUITE C
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-4971
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Country | US
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Telephone | 928-772-4500
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Fax | 928-772-2622
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Authorized Official
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Title or Position | MEMBER
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Name | DR. ANTHONY C. MULBERG
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Credential | D.C.-
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Telephone | 928-772-4500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC 23923
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 5361 - 386
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 5361
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License Number State | AZ
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