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General NPI Number Information
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NPI Number | 1922298207
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Entity Type | Organization
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Legal Business Name | RED ROCK FAMILY CHIROPRACTIC, P.C.
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Dates
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Enumeration Date | 08/01/2007
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Last Update Date | 08/23/2008
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Provider Practice Location Address
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Address Line | 17334 E TEJON DR
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City | FOUNTAIN HILLS
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State | AZ
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Zip | 85268-2665
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Country | US
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Telephone | 480-586-0574
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Fax | 480-816-4016
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Provider Business Mailing Address
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Address Line | 148 3RD AVE SE
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City | DICKINSON
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State | ND
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Zip | 58601-5636
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Country | US
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Telephone | 480-586-0574
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Fax | 480-816-4016
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JESSICA M DUKART
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Credential | D.C.
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Telephone | 480-816-8300
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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 | 5713
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License Number State | AZ
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