Individual provider Active NPI

Robert E Dahl, DC

  • Chiropractor
  • Flagstaff, AZ
National Provider Identifier
1114947090
Registry record updated Jun 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
854 Issued in AZ
Practice address
2717 N 4TH St
Suite 100
Flagstaff, AZ 86004-1813
Phone
(928) 774-1463
Fax
(928) 774-6039
NPI assigned
Jul 20, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 6, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 854 AZ Primary

Addresses

Primary practice location

2717 N 4TH St
Suite 100
Flagstaff, AZ 86004-1813

Mailing address

2717 N 4TH St
Suite 100
Flagstaff, AZ 86004-1813
Phone (928) 774-1463

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040825001208 AZ Practitioner - Chiropractic 7719963438 Receives reassigned benefits from 2 practitioners
Practice locations: Flagstaff, AZ; Holbrook, AZ; Tuba City, AZ

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 1968
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

163 W Hopi Dr
Holbrook, AZ 86025-2945
Phone (928) 524-2801

2717 N 4TH St
Suite 100
Flagstaff, AZ 86004-1813
Phone (928) 774-1463

322 Hwy 160
Suite 10
Tuba City, AZ 86045-1550
Phone (928) 283-5282

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Dahl Chiropractic Clinics Chiropractor CurrentSince Jan 1, 1990 Accepting new patients
R.M. Dahl Chiropractic & Functional Medicine, Inc. Chiropractor Past Accepting new patients
Tuba City Chiropractic and Acupuncture Chiropractor Past Accepting new patients
Chiropractic Joint LLC Chiropractor PastSince Apr 7, 2017 Accepting new patients

Locations

2717 N 4th St
Ste 100
Flagstaff, AZ 86004
Phone (928) 774-1463

163 W Hopi Dr
Holbrook, AZ 86025
Phone (928) 524-2801

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1338940800000",
    "number": "1114947090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2717 N 4TH ST",
            "address_2": "SUITE 100",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860041813",
            "telephone_number": "928-774-1463",
            "fax_number": "928-774-6039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2717 N 4TH ST",
            "address_2": "SUITE 100",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860041813",
            "telephone_number": "928-774-1463",
            "fax_number": "928-774-6039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAHL",
        "first_name": "ROBERT",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-20",
        "last_updated": "2012-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "AZ",
            "license": "854",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flagstaff, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.