Provider Demographics
NPI:1851657753
Name:CHIROPRACTIC REHAB AND NEUROLOGY INC
Entity Type:Organization
Organization Name:CHIROPRACTIC REHAB AND NEUROLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:623-587-0277
Mailing Address - Street 1:2525 W CAREFEE HWY BLD 1 SUITE 100
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:85086
Mailing Address - Country:US
Mailing Address - Phone:623-587-0277
Mailing Address - Fax:623-587-0270
Practice Address - Street 1:2525 W CAREFEE HWY BLD 1 SUITE 100
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:85086
Practice Address - Country:US
Practice Address - Phone:623-587-0277
Practice Address - Fax:623-587-0270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5518261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ62219Medicare UPIN