Provider Demographics
NPI:1033254172
Name:LITCHFIELD PARK CHIROPRACTIC, PLC
Entity Type:Organization
Organization Name:LITCHFIELD PARK CHIROPRACTIC, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HUPPERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MUAC
Authorized Official - Phone:623-935-1999
Mailing Address - Street 1:549 E PLAZA CIR
Mailing Address - Street 2:SUITE B
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-4918
Mailing Address - Country:US
Mailing Address - Phone:623-935-1999
Mailing Address - Fax:623-535-0848
Practice Address - Street 1:549 E PLAZA CIR
Practice Address - Street 2:SUITE B
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-4918
Practice Address - Country:US
Practice Address - Phone:623-935-1999
Practice Address - Fax:623-535-0848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4819111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0250020OtherBLUE CROSS BLUE SHIELD
AZ024995Medicare UPIN
AZDC4819Medicare ID - Type Unspecified