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General NPI Number Information
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NPI Number | 1902270424
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Entity Type | Organization
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Legal Business Name | QUAIL RIDGE MEDICAL LLC
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Dates
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Enumeration Date | 11/20/2015
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Last Update Date | 07/15/2016
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Provider Practice Location Address
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Address Line | 2331 HUALAPAI MOUNTAIN RD SUITE A
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City | KINGMAN
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State | AZ
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Zip | 86401-6207
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Country | US
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Telephone | 928-529-5086
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Fax | 928-529-5089
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Provider Business Mailing Address
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Address Line | 2331 HUALAPAI MOUNTAIN RD SUITE A
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City | KINGMAN
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State | AZ
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Zip | 86401-6207
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Country | US
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Telephone | 928-529-5086
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Fax | 928-529-5089
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Authorized Official
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Title or Position | OWNER/AUTHORIZED OFFICIAL
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Name | MR. ERNEST SHAYNE MONSON
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Credential | NP, DC
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Telephone | 928-529-5086
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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