Provider Demographics
NPI:1649589953
Name:HIGH DESERT CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:HIGH DESERT CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:THORNTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:928-753-5554
Mailing Address - Street 1:2401 STOCKTON HILL RD
Mailing Address - Street 2:STE 105
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-4189
Mailing Address - Country:US
Mailing Address - Phone:928-753-5554
Mailing Address - Fax:928-753-5855
Practice Address - Street 1:2401 STOCKTON HILL RD
Practice Address - Street 2:STE 105
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-4189
Practice Address - Country:US
Practice Address - Phone:928-753-5554
Practice Address - Fax:928-753-5855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7101261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0943320OtherBCBS
AZV03849Medicare UPIN
AZ101304Medicare PIN