Provider Demographics
NPI:1235461005
Name:DR DAHL LLC
Entity Type:Organization
Organization Name:DR DAHL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DAHL
Authorized Official - Suffix:
Authorized Official - Credentials:DC, FIACA
Authorized Official - Phone:623-582-6141
Mailing Address - Street 1:3414 W UNION HILLS DR
Mailing Address - Street 2:SUITE # 13
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4899
Mailing Address - Country:US
Mailing Address - Phone:623-582-6141
Mailing Address - Fax:623-581-1924
Practice Address - Street 1:3414 W UNION HILLS DR
Practice Address - Street 2:SUITE # 13
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4899
Practice Address - Country:US
Practice Address - Phone:623-582-6141
Practice Address - Fax:623-581-1924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4405111N00000X
AZ124171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZT00285Medicare UPIN