Provider Demographics
NPI:1508059494
Name:MOUNTAIN DOVE CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:MOUNTAIN DOVE CHIROPRACTIC INC.
Other - Org Name:MOUNTAIN DOVE CHIROPRACTIC CLINIC P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:VIAFORA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:928-284-9550
Mailing Address - Street 1:5 NAVAJO RD
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86351-8927
Mailing Address - Country:US
Mailing Address - Phone:928-284-9550
Mailing Address - Fax:
Practice Address - Street 1:5 NAVAJO RD
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86351-8927
Practice Address - Country:US
Practice Address - Phone:928-284-9550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ75249Medicare PIN