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General NPI Number Information
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NPI Number | 1770768475
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Entity Type | Organization
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Legal Business Name | COTTONWOOD CHIROPRACTIC, INC
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Dates
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Enumeration Date | 01/02/2008
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Last Update Date | 01/10/2008
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Provider Practice Location Address
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Address Line | 1770 E VILLA DR SUITE #5
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City | COTTONWOOD
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State | AZ
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Zip | 86326-4647
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Country | US
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Telephone | 928-634-7930
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Fax | 928-634-7930
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Provider Business Mailing Address
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Address Line | 1770 E VILLA DR SUITE #5
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City | COTTONWOOD
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State | AZ
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Zip | 86326-4647
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Country | US
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Telephone | 928-634-7930
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Fax | 928-634-7930
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Authorized Official
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Title or Position | CEO, PRESIDENT
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Name | DR. KRISTIE LYNNE KREUTZFELD
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Credential | D.C.
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Telephone | 928-634-3852
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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 | DC4916
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License Number State | AZ
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