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General NPI Number Information
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NPI Number | 1932387511
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Entity Type | Organization
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Legal Business Name | MOUNTAIN CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 02/05/2008
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Last Update Date | 03/27/2008
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Provider Practice Location Address
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Address Line | 411 S BEELINE HWY SUITE C
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City | PAYSON
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State | AZ
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Zip | 85541-4892
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Country | US
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Telephone | 928-474-8417
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Fax | 928-474-8417
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Provider Business Mailing Address
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Address Line | 411 S BEELINE HWY SUITE C
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City | PAYSON
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State | AZ
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Zip | 85541-4892
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Country | US
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Telephone | 928-474-8417
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Fax | 928-474-8417
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DANIEL S. FLAKE
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Credential | DC, CCSP
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Telephone | 928-474-8417
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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 | DC3716
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License Number State | AZ
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