Organization
RETAIL AUTOMATION USA LLC
Active
Other names
MUNDERLOH CHIROPRACTIC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK LOVE (CEO)
(928) 556-0707
Entity
Organization
Contact information
Practice address
1501 S YALE ST, SUITE 250, FLAGSTAFF, AZ 86001-7304
(928) 556-0707
(928) 779-2223
Mailing address
1501 S YALE ST, SUITE 250, FLAGSTAFF, AZ 86001-7304
(928) 556-0707
(928) 779-2223
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
5935
AZ
111NN0400X
Neurology Chiropractor
Primary
1058
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104883164
PROVIDER NPI
AZ
01
—
5935
CHIROPRACTIC LICENCE
AZ
01
—
AZ09441160
BCBS AZ NUMBER
AZ
Enumeration date
01/31/2007
Last updated
05/18/2012
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