Provider Demographics
NPI:1427223510
Name:DINE HEALTHCARE PC
Entity Type:Organization
Organization Name:DINE HEALTHCARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRSTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:928-871-3556
Mailing Address - Street 1:PO BOX 666
Mailing Address - Street 2:
Mailing Address - City:WINDOW ROCK
Mailing Address - State:AZ
Mailing Address - Zip Code:86515
Mailing Address - Country:US
Mailing Address - Phone:928-871-3556
Mailing Address - Fax:928-871-3559
Practice Address - Street 1:HIGHWAY 264 ROUTE 12
Practice Address - Street 2:SUITE 11
Practice Address - City:WINDOW ROCK
Practice Address - State:AZ
Practice Address - Zip Code:86515
Practice Address - Country:US
Practice Address - Phone:928-871-3556
Practice Address - Fax:928-871-3559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3914111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0937390OtherBC/BS
AZ13499OtherHMA
AZAZ0937390OtherBC/BS