Organization
OUTBACK CHIROPRACTIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LANNY CRAIG CROCKETT DC (OWNER/PRESIDENT)
(928) 337-3125
Entity
Organization
Contact information
Practice address
1200 W. CLEVELAND, SAINT JOHNS, AZ 85936-1200
(928) 337-3125
(928) 337-3291
Mailing address
PO BOX 2578, SAINT JOHNS, AZ 85936-2578
(928) 337-3125
(928) 337-3291
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
841595
—
AZ
Enumeration date
02/06/2008
Last updated
02/06/2008
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