Provider Demographics
NPI:1184660011
Name:FIRST CHIROPRACTIC - PRINCE LLC
Entity Type:Organization
Organization Name:FIRST CHIROPRACTIC - PRINCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:ONEAL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:520-886-4213
Mailing Address - Street 1:1435 W PRINCE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-3013
Mailing Address - Country:US
Mailing Address - Phone:520-888-5090
Mailing Address - Fax:520-888-0234
Practice Address - Street 1:1435 W PRINCE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-3013
Practice Address - Country:US
Practice Address - Phone:520-888-5090
Practice Address - Fax:520-888-0234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z62566Medicare PIN