PROFORMA HEALTH PLLC (NPI# 1326393927) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326393927 |
| Entity Type | Organization |
| Organization Name | PROFORMA HEALTH PLLC |
| Other Organization Name | MUNDERLOH CHIROPRACTIC |
| Practice Address |
1501 S Yale St Suite 250 Flagstaff AZ 86001-7304 |
| Practice Telephone | 9285560707 |
| Practice Fax Number | 9287792223 |
| Mailing Telephone | 9285560707 |
| Mailing Fax Number | 9287792223 |
| Enumeration Date | 2012-07-19 |
| Last Update Date | 2012-07-19 |
| Authorized Official Name | DR. TIMOTHY JAMES MUNDERLOH (PRESIDENT) |
| Authorized Official Telephone | 9285560707 |
| Authorized Official Credential | D.C. |
| Is Organization Subpart | Y |
| Parent Organization Name | MUNDERLOH HOLDINGS LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 111NN0400X |
Chiropractor Specialization: Neurology |
Chiropractic Providers | ||
| Y | 111N00000X | Chiropractor | Chiropractic Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | CHIROPRACTIC LICENSE | 5935 | 01 |
| AZ | PROVIDER NPI | 1104883164 | 01 |
| Other Name | Type Code |
|---|---|
| MUNDERLOH CHIROPRACTIC | Doing Business As Name - Organization |
| Street Address |
1501 S YALE ST SUITE 250 |
| City | FLAGSTAFF |
| State | AZ |
| Zip Code | 86001-7304 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003811068 | Christine Crowder | General Practice | 1501 S Yale St, Bldg 2 Suite 150, Flagstaff, AZ 86001-7304 | 2005-06-16 |
| 1669911764 | North Country Healthcare, Inc. | Pediatrics | 1501 S Yale St, Ste 252, Flagstaff, AZ 86001-7304 | 2017-02-22 |
| 1174074991 | Elysia Small | Physician Assistant | 1501 S Yale St, Building 2 Suite 150, Flagstaff, AZ 86001-7304 | 2016-10-17 |
| 1578910295 | Munderloh Medical LLC | Chiropractor | 1501 S Yale St, 250, Flagstaff, AZ 86001-7304 | 2016-05-23 |
| 1518309350 | Jeremy K Burdick | Nurse Practitioner | 1501 S Yale St, 252, Flagstaff, AZ 86001-7304 | 2013-07-22 |
| 1235371493 | Travis Clark Stiegler | Psychiatry & Neurology | 1501 S Yale St, Ste 250, Flagstaff, AZ 86001-7304 | 2009-04-01 |
| 1891825022 | Michelle Doroz | Family Medicine | 1501 S Yale St, Bldg 2 Suite 150, Flagstaff, AZ 86001-7304 | 2007-03-06 |
| 1417082553 | Theresa Dowell | Physical Therapist | 1501 S Yale St, Ste# 252, Flagstaff, AZ 86001-7304 | 2007-02-22 |
| 1447397336 | Retail Automation Usa LLC | Chiropractor | 1501 S Yale St, Suite 250, Flagstaff, AZ 86001-7304 | 2007-01-31 |
| 1285703918 | Flagstaff Primary Care, PC | Pediatrics | 1501 S Yale St, Ste #252, Flagstaff, AZ 86001-7304 | 2006-11-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427658756 | Marlenne Adair Escobar-mendoza | Specialist/Technologist | 1705 South San Francisco Street, Flagstaff, AZ 86001 | 2020-10-27 |
| 1962033712 | Laura-lee Prescott | Social Worker | Northern Az Va Healthcare System, Flagstaff Cboc, 1300 W. University Ave., Suite 300, Flagstaff, AZ 86001 | 2020-01-30 |
| 1194360784 | Trinity Medical Consultants Pllc | Internal Medicine | 1521 N Cliff Drive, Flagstaff, AZ 86001 | 2019-11-07 |
| 1154849610 | Altacare, LLC | Family Medicine | 2700 S Woodlands Village Blvd Ste 700, Flagstaff, AZ 86001 | 2017-09-05 |
| 1487174926 | Lindsey Marie Forstie | Nurse Practitioner | 7263 E Dreamview Trail, Flagstaff, AZ 86001 | 2017-06-26 |
| 1255860763 | Welbrook Senior Living Flagstaff LLC | Skilled Nursing Facility | 1521 N Pine Cliff Dr, Flagstaff, AZ 86001 | 2017-06-08 |
| 1912432675 | Ryan Tiscareno | Specialist/Technologist | 621 West Cherry Ave, Flagstaff, AZ 86001 | 2017-05-01 |
| 1629432380 | Behavioral Consultation Services, Inc. | Clinic/Center | 345 S. River Run Road, Suite 200, Flagstaff, AZ 86001 | 2016-04-08 |
| 1275920928 | Junli Gallagher | Speech-Language Pathologist | 1215 N. Beaver St, Flagstaff, AZ 86001 | 2015-04-21 |
| 1932592599 | Kristen Flugstad Psyd, LLC | Psychologist | 125 East Elm Avenue #203, Flagstaff, AZ 86001 | 2015-03-06 |
| Find all providers in zip 86001 | ||||
| Taxonomy Code | 111N00000X |
| Grouping | Chiropractic Providers |
| Classification | Chiropractor |
| A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710308267 | Wesley Gregg | Chiropractor | 2201 N Gemini Dr, Flagstaff, AZ 86001-1637 | 2013-12-31 |
| 1962754390 | Shana Marie Gorman-dunn | Chiropractor | 2717 N 4th St Ste 100, Flagstaff, AZ 86004-1813 | 2012-10-09 |
| 1295085348 | Andrew J Gregg | Chiropractor | 1501 S Yale St Ste 250, Flagstaff, AZ 86001-7336 | 2012-09-17 |
| 1891015673 | The Chiropractor, Dr Weathersby, LLC | Chiropractor | 1585 S Plaza Way Ste 150, Flagstaff, AZ 86001-7156 | 2010-06-03 |
| 1891946398 | Lisa Christine Connor | Chiropractor | 201 S Leroux St, Flagstaff, AZ 86001-5627 | 2008-10-02 |
| 1942475561 | Back & Neck Center P.C. | Chiropractor | 2001 N. 4th St., Flagstaff, AZ 86004-2001 | 2008-04-24 |
| 1124218086 | Kymberlee Wilkens | Chiropractor | 715 N Humphreys St, Flagstaff, AZ 86001-3025 | 2007-07-26 |
| 1265658249 | Eric D Sanders | Chiropractor | 323 N Agassiz St, Flagstaff, AZ 86001-4604 | 2007-04-18 |
| 1912121583 | Dennis William Kirsten | Chiropractor | 1750 Railroad Springs Blvd, Suite 3, Flagstaff, AZ 86001 | 2007-04-12 |
| 1023131893 | Jeff Rex Alfred | Chiropractor | 2733 E Lakin Dr, Suite 3, Flagstaff, AZ 86004-3951 | 2007-04-09 |
| Find all providers in FLAGSTAFF | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.