Provider Demographics
NPI:1013250083
Name:BRIMHALL, RICHARD (DC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:BRIMHALL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 N WHITE MOUNTAIN RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-5298
Mailing Address - Country:US
Mailing Address - Phone:928-251-1477
Mailing Address - Fax:
Practice Address - Street 1:151 N WHITE MOUNTAIN RD
Practice Address - Street 2:SUITE A
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-5298
Practice Address - Country:US
Practice Address - Phone:928-251-1477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8285111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor