Provider Demographics
NPI:1073798112
Name:RINCON CHIROPRACTIC ASSOCIATES
Entity Type:Organization
Organization Name:RINCON CHIROPRACTIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:520-323-2888
Mailing Address - Street 1:2122 N. CRAYCROFT ROAD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2829
Mailing Address - Country:US
Mailing Address - Phone:520-323-2888
Mailing Address - Fax:520-323-9102
Practice Address - Street 1:2122 N. CRAYCROFT ROAD
Practice Address - Street 2:SUITE 112
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2829
Practice Address - Country:US
Practice Address - Phone:520-323-2888
Practice Address - Fax:520-323-9102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4082111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ22955Medicare PIN