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General NPI Number Information
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NPI Number | 1336682731
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Entity Type | Organization
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Legal Business Name | AQUA FRIA HEALTH CENTER LLC
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Dates
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Enumeration Date | 12/02/2016
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Last Update Date | 12/02/2016
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Provider Practice Location Address
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Address Line | 12150 E TURQUOISE CIR
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City | DEWEY
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State | AZ
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Zip | 86327-5739
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Country | US
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Telephone | 928-775-7221
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Fax | 928-775-7223
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Provider Business Mailing Address
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Address Line | 12150 E TURQUOISE CIR
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City | DEWEY
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State | AZ
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Zip | 86327-5739
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Country | US
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Telephone | 928-775-7221
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Fax | 928-775-7223
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Authorized Official
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Title or Position | MEMBER
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Name | SHEILA LEE RANDALL
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Credential |
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Telephone | 929-775-7221
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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 | 4544
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License Number State | AZ
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