Provider Demographics
NPI:1982899894
Name:FOOTHILLS CHIROPRACTIC CLINIC, PC
Entity Type:Organization
Organization Name:FOOTHILLS CHIROPRACTIC CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JURGEN
Authorized Official - Middle Name:
Authorized Official - Last Name:OLTJENBRUNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-488-1282
Mailing Address - Street 1:PO BOX 232
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85327-0232
Mailing Address - Country:US
Mailing Address - Phone:480-488-1282
Mailing Address - Fax:480-488-9040
Practice Address - Street 1:7208 E. CAVE CREEK ROAD
Practice Address - Street 2:
Practice Address - City:CAREFREE
Practice Address - State:AZ
Practice Address - Zip Code:85377
Practice Address - Country:US
Practice Address - Phone:480-488-1282
Practice Address - Fax:480-488-9040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5283111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U92037Medicare UPIN
U52245Medicare UPIN
Z71528Medicare PIN