Kingman Chiropractic Clinic PC
Organization Active NPI Chiropractor · Kingman, AZ
NPI 1003970930 · NPPES record last updated Jul 11, 2008
Key facts
- NPI
- 1003970930
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- Legal business name
- KINGMAN CHIROPRACTIC CLINIC PC
- Practice address
- 1910 Lucille Ave
Kingman, AZ 86401-4693 - Phone
- (928) 753-2047
- Fax
- (928) 753-2020
- NPI assigned
- Dec 22, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Ryan D Gustafson, DC
- Title
- President
- Phone
- (928) 753-2047
Practitioners 10
-
Ryan Dennis Gustafson, D.C.
-
David M Bleiler, D.C.
-
Laura Joy Gustafson, D.C.
-
Patricia D Haydon, D.C.
-
Ernest S Monson, NP
-
Derek Patrick Price, D.C.
-
Thomas W. Schrimsher, D.C.
-
Aza Thompson, D.C.
-
Craig Allan Werner, D.C.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080701000598 | AZ | Part B Supplier - Clinic/Group Practice | 5395817696 |
Receives reassigned benefits from 1 practitioner Practice locations: Kingman, AZ |
National Provider Directory
Locations
1910 Lucille Ave
Ste 1
Kingman, AZ 86401
Phone (602) 753-2047
1910 Lucille Ave
Kingman, AZ 86401
Phone (928) 753-2047
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | Yes |
Addresses
Primary practice location
1910 Lucille Ave
Kingman, AZ 86401-4693
Mailing address
1910 Lucille Ave
Kingman, AZ 86401-4693
Phone (928) 753-2047
Other names
- Dennis D and Ryan D Gustafson DC
Other providers in Kingman, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 11, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.