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General NPI Number Information
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NPI Number | 1851657753
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC REHAB AND NEUROLOGY INC
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Dates
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Enumeration Date | 04/04/2012
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Last Update Date | 04/04/2012
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Provider Practice Location Address
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Address Line | 2525 W CAREFEE HWY BLD 1 SUITE 100
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City | FLAGSTAFF
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State | AZ
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Zip | 85086
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Country | US
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Telephone | 623-587-0277
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Fax | 623-587-0270
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Provider Business Mailing Address
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Address Line | 2525 W CAREFEE HWY BLD 1 SUITE 100
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City | FLAGSTAFF
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State | AZ
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Zip | 85086
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Country | US
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Telephone | 623-587-0277
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Fax | 623-587-0270
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TIMOTHY FRANK MARTIN
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Credential | DC
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Telephone | 623-587-0277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 5518
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License Number State | AZ
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