| Organization Name: | NORTHERN ARIZONA HEALTHCARE PROVIDER GROUP, LLC |
| NPI Number: | 1154689966 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHRISTINE M MARTIN (CEO) |
| Mailing Address: | 450 South Willard Street Suite 107 Cottonwood |
| State: | AZ US |
| Postal Code: | 863266744 |
| Phone Number: | 9286497991 |
| Fax Number: | |
| NPI Enumeration Date: | 04/30/2012 |
| NPI Last Update Date: | 12/03/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 204D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Neuromusculoskeletal Medicine & OMM |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |