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LAKESIDE CHIROPRACTIC PC NPI 1417133265


NPI Information

NPI: 1417133265
Provider Name: LAKESIDE CHIROPRACTIC PC
Classification: Clinic/Center - 261Q00000X
Entity Type: Organization
Address:
1640 E OLIVER PL
SHOW LOW, AZ
ZIP 85901
Phone: (928) 532-1225
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LAKESIDE CHIROPRACTIC PC is a clinic center in Show Low, AZ. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). LAKESIDE CHIROPRACTIC PC NPI is 1417133265. The provider is registered as an organization entity type.

The provider's business location address is:

1640 E OLIVER PL
SHOW LOW, AZ
ZIP 85901-117
Phone: (928) 532-1225
Fax: (928) 532-2276

The provider's authorized official is Richard Albert Boatright .
The authorized official title is President and has the following contact phone number (928) 532-1225.

The enumeration date for this NPI number is 1/10/2008 and was last updated on 3/7/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261Q00000XClinic/Center5129ARIZONAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
169963MEDICARE PINARIZONA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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