Provider Demographics
NPI:1760871859
Name:LAKE HAVASU CHIROPRACTIC
Entity Type:Organization
Organization Name:LAKE HAVASU CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:FINKLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:928-680-1123
Mailing Address - Street 1:1674 MCCULLOCH BLVD N
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-0962
Mailing Address - Country:US
Mailing Address - Phone:928-680-1123
Mailing Address - Fax:928-680-3203
Practice Address - Street 1:1674 MCCULLOCH BLVD N
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-0962
Practice Address - Country:US
Practice Address - Phone:928-680-1123
Practice Address - Fax:928-680-3203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5295111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty