Provider Demographics
NPI:1053486506
Name:R.M. DAHL CHIROPRACTIC & FUNCTIONAL MEDICINE, INC.
Entity Type:Organization
Organization Name:R.M. DAHL CHIROPRACTIC & FUNCTIONAL MEDICINE, INC.
Other - Org Name:R.M. DAHL CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DAHL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:928-226-7191
Mailing Address - Street 1:2622 N STEVES BLVD
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-3938
Mailing Address - Country:US
Mailing Address - Phone:928-226-7191
Mailing Address - Fax:928-526-5767
Practice Address - Street 1:2622 N STEVES BLVD
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-3938
Practice Address - Country:US
Practice Address - Phone:928-226-7191
Practice Address - Fax:928-526-5767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5436111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty