Provider Demographics
NPI:1891054383
Name:MOHAVE FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:MOHAVE FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAKENZIE
Authorized Official - Middle Name:JANEL
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:928-279-2406
Mailing Address - Street 1:3931 STOCKTON HILL RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-2426
Mailing Address - Country:US
Mailing Address - Phone:928-681-2300
Mailing Address - Fax:928-681-3330
Practice Address - Street 1:3931 STOCKTON HILL RD
Practice Address - Street 2:SUITE C
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-2426
Practice Address - Country:US
Practice Address - Phone:928-681-2300
Practice Address - Fax:928-681-3330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-03
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8258111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty