Provider Demographics
NPI:1851424527
Name:FIRST CHIROPRACTIC OF KINGMAN
Entity Type:Organization
Organization Name:FIRST CHIROPRACTIC OF KINGMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTIC
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAYDON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:928-757-2800
Mailing Address - Street 1:2139 AIRWAY AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3669
Mailing Address - Country:US
Mailing Address - Phone:928-757-2800
Mailing Address - Fax:928-757-2772
Practice Address - Street 1:2139 AIRWAY AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-3669
Practice Address - Country:US
Practice Address - Phone:928-757-2800
Practice Address - Fax:928-757-2772
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST CHIROPRACTIC OF KINGMAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-13
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4146111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZT41699Medicare UPIN
AZZWCKDMMedicare PIN