Outback Chiropractic LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

OUTBACK CHIROPRACTIC LLC

Practice address

1200 W. Cleveland
Saint Johns, AZ 85936-1200

Phone

(928) 337-3125

Fax

(928) 337-3291

NPI assigned

Feb 6, 2008

Organization subpart

No

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

Authorized official

Name

Lanny Craig Crockett, DCNPI 1780644195

Title

Owner/President

Phone

(928) 337-3125

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

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

• Lanny Craig Crockett, DC

  • Chiropractor
  • Snowflake, AZ
  • NPI 1780644195
  NPD (past) Authorized official

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

{
    "created_epoch": "1202256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202256000000",
    "number": "1811175482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2578",
            "city": "SAINT JOHNS",
            "state": "AZ",
            "postal_code": "859362578",
            "telephone_number": "928-337-3125",
            "fax_number": "928-337-3291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 W. CLEVELAND",
            "city": "SAINT JOHNS",
            "state": "AZ",
            "postal_code": "859361200",
            "telephone_number": "928-337-3125",
            "fax_number": "928-337-3291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUTBACK CHIROPRACTIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-06",
        "last_updated": "2008-02-06",
        "status": "A",
        "authorized_official_last_name": "CROCKETT",
        "authorized_official_first_name": "LANNY",
        "authorized_official_middle_name": "CRAIG",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "928-337-3125",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "841595",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daisy Morales, LPC
• Ellen Patricia Morse, CFNP
• North Country Healthcare, Inc.
• North Country Healthcare, Inc.
• Paul Delbert Otto, LMFT
• Ralph Adam Patterson, M.D.
• Rodney Scott Poche, LMFT
• Randolph P Platt DDS, PC
• Richie P Bast MD Incorporated
• Sentient Harbor LLC

• Chiropractor in Saint Johns, AZ
• Providers in Saint Johns, AZ by specialty
• Chiropractor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.