Provider Demographics
NPI:1326395757
Name:SUMMIT CHIROPRACTIC & REHABILITATION INC
Entity Type:Organization
Organization Name:SUMMIT CHIROPRACTIC & REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BELCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:928-699-0512
Mailing Address - Street 1:519 N LEROUX ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3221
Mailing Address - Country:US
Mailing Address - Phone:928-774-7315
Mailing Address - Fax:
Practice Address - Street 1:519 N LEROUX ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3221
Practice Address - Country:US
Practice Address - Phone:928-774-7315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-03
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7734111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty