OUTBACK CHIROPRACTIC LLC (NPI# 1811175482) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811175482 |
| Entity Type | Organization |
| Organization Name | OUTBACK CHIROPRACTIC LLC |
| Practice Address |
1200 W. Cleveland Saint Johns AZ 85936-1200 |
| Mailing Address |
Po Box 2578 Saint Johns AZ 85936-2578 |
| Practice Telephone | 9283373125 |
| Practice Fax Number | 9283373291 |
| Mailing Telephone | 9283373125 |
| Mailing Fax Number | 9283373291 |
| Enumeration Date | 2008-02-06 |
| Last Update Date | 2008-02-06 |
| Authorized Official Name | LANNY CRAIG CROCKETT (OWNER/PRESIDENT) |
| Authorized Official Telephone | 9283373125 |
| Authorized Official Credential | DC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 111N00000X | Chiropractor | Chiropractic Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | 841595 | 05 |
| Street Address |
1200 W. CLEVELAND |
| City | SAINT JOHNS |
| State | AZ |
| Zip Code | 85936-1200 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669936050 | Compass Medical Center Snowflake, Pllc | General Practice | 2744 W. Plum Blossom Lane, Snowflake, AZ 85936 | 2019-01-30 |
| 1497277651 | White Mountain Regional Medical Center Rural Health Clinic - St. Johns | Clinic/Center | 110 East First Street South, St. Johns, AZ 85936 | 2017-07-10 |
| 1487103297 | Brittany Gray | Physical Therapy Assistant | 80 South 13th West, St. Johns, AZ 85936 | 2016-09-22 |
| 1407226269 | Martha Mcguffin | Nurse Practitioner | 625 N 13th West, St Johns, AZ 85936 | 2015-10-05 |
| 1962808337 | April Marie Allen | Specialist/Technologist | 50 N Water, St Johns, AZ 85936 | 2014-11-13 |
| 1588985808 | Brenon K Farmer | Dentist | 860 W. Cleveland, Suite 5, Saint Johns, AZ 85936 | 2010-06-22 |
| 1306163258 | Marvin Cabilangan Depas | Nurse Practitioner | 625 N. 13th West, North Country Healthcare, St Johns, Saint Johns, AZ 85936 | 2010-04-30 |
| 1518196682 | Candice Bond | Speech-Language Pathologist | 555 West 7th South, Saint Johns, AZ 85936 | 2009-07-09 |
| 1699903757 | Carl S Wiltbank | Physical Therapist | 80 S 13th West, St. Johns, AZ 85936 | 2009-06-29 |
| 1063604965 | Joseph Donovan Tenney | Dentist | 100 North 13th West, Saint Johns, AZ 85936 | 2007-08-14 |
| Find all providers in zip 85936 | ||||
| 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 |
|---|---|---|---|---|
| 1518466309 | Developing Growth Again, LLC | Chiropractor | 1375 River Chase Dr, Saint Johns, FL 32259-9081 | 2018-02-07 |
| 1346749637 | Holly Graham | Chiropractor | 1051 S Us Highway 27, Saint Johns, MI 48879-2437 | 2018-02-01 |
| 1285142190 | Michaele E Bailey | Chiropractor | 774 State Road 13 Ste 7, Saint Johns, FL 32259-3815 | 2018-01-12 |
| 1942509641 | Thomas Edward Danisiewicz | Chiropractor | 324 Blackthorn Pl, Saint Johns, FL 32259-5916 | 2011-03-21 |
| 1285819169 | St. Johns Chiropractic Clinic, Inc. | Chiropractor | 1004 N Us Highway 27, Saint Johns, MI 48879-1129 | 2008-01-09 |
| 1013084656 | Leslie Anne Lynn | Chiropractor | 445 State Road 13, Suite #9, Saint Johns, FL 32259 | 2006-11-29 |
| 1508931528 | Ryan Cole Brewer | Chiropractor | 1200 W Cleveland, Suite 6, Saint Johns, AZ 85936-2578 | 2006-11-22 |
| 1518322825 | Tyler Lynn Dickenson | Chiropractor | 1004 N Us Highway 27, Saint Johns, MI 48879-1129 | 2015-12-31 |
| 1174829477 | Maureen Louise Barry | Chiropractor | 1059 S Us Highway 27, Saint Johns, MI 48879-2437 | 2011-02-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437750528 | Innovative Pain and Wellness Plc | Chiropractor | 8110 W Union Hills Dr Ste 320, Glendale, AZ 85308-8181 | 2020-11-04 |
| 1881293058 | Modern Chiropractic Company Pllc | Chiropractor | 670 N 54th St Ste 1, Chandler, AZ 85226-1529 | 2020-10-20 |
| 1487260436 | Chiropure Spine & Injury | Chiropractor | 950 E Baseline Rd Ste 104, Tempe, AZ 85283-1689 | 2020-09-16 |
| 1396359626 | Adapt Chiropractic Pllc | Chiropractor | 1728 S Greenfield Rd Ste 109, Mesa, AZ 85206-3484 | 2020-09-03 |
| 1780294835 | Jacquelyn Rose Lewison | Chiropractor | 2055 N Kolb Rd, Tucson, AZ 85715-4099 | 2020-08-04 |
| 1023628476 | The Wellness Way North Phoenix LLC | Chiropractor | 34406 N 27th Dr Ste 139, Phoenix, AZ 85085-7733 | 2020-07-31 |
| 1114535366 | Brian Anthony Romero | Chiropractor | 230 S 3rd St Ste B3, Phoenix, AZ 85004-2697 | 2020-07-14 |
| 1699391052 | Emily Weber | Chiropractor | 3426 E Baseline Rd, Mesa, AZ 85204-7291 | 2020-06-22 |
| 1841815552 | Madera Chiropractic Pllc | Chiropractor | 560 E Continental Rd Unit 102, Green Valley, AZ 85614-1825 | 2020-06-09 |
| 1194351379 | Sport and Spine Chiropractic Pllc | Chiropractor | 2155 E University Dr Ste 111, Tempe, AZ 85281-4685 | 2020-03-19 |
| Find all providers with the same taxonomy | ||||
| City | SAINT JOHNS |
| Zip Code | 85936 |
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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.