Provider Demographics
NPI:1962557793
Name:JOHN PAUL FUTRAL DC PLLC
Entity type:Organization
Organization Name:JOHN PAUL FUTRAL DC PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:FUTRAL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:928-775-3125
Mailing Address - Street 1:PO BOX 26987
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86312-6987
Mailing Address - Country:US
Mailing Address - Phone:928-775-3125
Mailing Address - Fax:928-775-3128
Practice Address - Street 1:8098 E STATE ROUTE 69
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-9403
Practice Address - Country:US
Practice Address - Phone:928-775-3125
Practice Address - Fax:928-775-3128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ101270Medicare PIN