Provider Demographics
NPI:1770768475
Name:COTTONWOOD CHIROPRACTIC, INC
Entity type:Organization
Organization Name:COTTONWOOD CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:KREUTZFELD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:928-634-3852
Mailing Address - Street 1:1770 E VILLA DR
Mailing Address - Street 2:SUITE #5
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-4647
Mailing Address - Country:US
Mailing Address - Phone:928-634-7930
Mailing Address - Fax:928-634-7930
Practice Address - Street 1:1770 E VILLA DR
Practice Address - Street 2:SUITE #5
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4647
Practice Address - Country:US
Practice Address - Phone:928-634-7930
Practice Address - Fax:928-634-7930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDC4916111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ73771Medicare PIN