MEDICARE: DINE HEALTHCARE PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3914	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AZ0937390	OTHER	AZ	BC/BS
2	13499	OTHER	AZ	HMA

General Provider Information

NPI Number	:	1427223510
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DINE HEALTHCARE PC

Provider Business Mailing Address
First Line	:	PO BOX 666
Second Line	:
City	:	WINDOW ROCK
State	:	AZ
Zip	:	86515
Country	:	US
Telephone Number	:	928-871-3556
Fax Number	:	928-871-3559

Provider Business Practice Location Address
First Line	:	HIGHWAY 264 ROUTE 12
Second Line	:	SUITE 11
City	:	WINDOW ROCK
State	:	AZ
Zip	:	86515
Country	:	US
Telephone Number	:	928-871-3556
Fax Number	:	928-871-3559

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DENNIS KIRSTEN
Credential	:	D.C.
Telephone Number	:	928-871-3556

Provider Enumeration Date	:	04/29/2008
Last Update Date	:	04/29/2008

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Directions to “DINE HEALTHCARE PC ” Practice Location

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