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General NPI Number Information
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NPI Number | 1578838397
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Entity Type | Organization
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Legal Business Name | EAGAR FAMILY CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 03/12/2012
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Last Update Date | 04/05/2012
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Provider Practice Location Address
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Address Line | 674 W CENTRAL AVE
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City | EAGAR
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State | AZ
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Zip | 85925-9706
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Country | US
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Telephone | 928-333-2225
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Fax |
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Provider Business Mailing Address
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Address Line | 674 W CENTRAL AVE
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City | EAGAR
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State | AZ
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Zip | 85925-9706
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Country | US
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Telephone | 928-333-2225
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEVIN M EAGAR
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Credential | DC
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Telephone | 928-551-5107
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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 | 8235
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License Number State | AZ
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