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General NPI Number Information
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NPI Number | 1649589953
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Entity Type | Organization
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Legal Business Name | HIGH DESERT CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 10/04/2010
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Last Update Date | 10/04/2010
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Provider Practice Location Address
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Address Line | 2401 STOCKTON HILL RD STE 105
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City | KINGMAN
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State | AZ
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Zip | 86401-4189
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Country | US
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Telephone | 928-753-5554
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Fax | 928-753-5855
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Provider Business Mailing Address
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Address Line | 2401 STOCKTON HILL RD STE 105
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City | KINGMAN
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State | AZ
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Zip | 86401-4189
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Country | US
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Telephone | 928-753-5554
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Fax | 928-753-5855
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Authorized Official
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Title or Position | OWNER/CHIROPRACTIC
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Name | DR. ROBERT THORNTON
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Credential | D.C.
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Telephone | 928-753-5554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 7101
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License Number State | AZ
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