Provider Demographics
NPI:1174950943
Name:CHAMPION CHIROPRACTIC
Entity type:Organization
Organization Name:CHAMPION CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KRAHL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-595-0001
Mailing Address - Street 1:PO BOX 2872
Mailing Address - Street 2:
Mailing Address - City:CAREFREE
Mailing Address - State:AZ
Mailing Address - Zip Code:85377-2872
Mailing Address - Country:US
Mailing Address - Phone:480-595-0001
Mailing Address - Fax:480-595-9599
Practice Address - Street 1:7202 E. CAREFREE DR
Practice Address - Street 2:BLDG. 1 SUITE B
Practice Address - City:CAREFREE
Practice Address - State:AZ
Practice Address - Zip Code:85377-2872
Practice Address - Country:US
Practice Address - Phone:480-595-0001
Practice Address - Fax:480-595-9599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-10
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4822111N00000X
AZ8173111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COV08898Medicare UPIN