Basic Information
| Provider Information | |||||||||
| NPI: | 1922298207 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RED ROCK FAMILY CHIROPRACTIC, P.C. | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 148 3RD AVE SE | ||||||||
| Address2: | |||||||||
| City: | DICKINSON | ||||||||
| State: | ND | ||||||||
| PostalCode: | 586015636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805860574 | ||||||||
| FaxNumber: | 4808164016 | ||||||||
| Practice Location | |||||||||
| Address1: | 17334 E TEJON DR | ||||||||
| Address2: | |||||||||
| City: | FOUNTAIN HILLS | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852682665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805860574 | ||||||||
| FaxNumber: | 4808164016 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2007 | ||||||||
| LastUpdateDate: | 08/23/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | DUKART | ||||||||
| AuthorizedOfficialFirstName: | JESSICA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4808168300 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.C. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 5713 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.