Provider Demographics
NPI:1558587089
Name:KLITZKE FAMILY CHIROPRACTIC & REHAB, LLC
Entity Type:Organization
Organization Name:KLITZKE FAMILY CHIROPRACTIC & REHAB, LLC
Other - Org Name:APACHE GOLD CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:KLITZKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-671-6710
Mailing Address - Street 1:189 W APACHE TRL # A101
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85220-3435
Mailing Address - Country:US
Mailing Address - Phone:480-671-6710
Mailing Address - Fax:480-671-6713
Practice Address - Street 1:189 W APACHE TRL # A101
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85220-3435
Practice Address - Country:US
Practice Address - Phone:480-671-6710
Practice Address - Fax:480-671-6713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7010111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ84810Medicare ID - Type Unspecified