03D2078474 CLIA NUMBER - KINGMAN CHIROPACTIC CLINIC

Laboratory Demographics

  • CLIA Code: 03D2078474
  • Facility Name: KINGMAN CHIROPACTIC CLINIC
  • Facility Address: 1910 LUCILLE AVE
    KINGMAN, AZ
    ZIP 86401
  • Facility Phone: 928 753-2047
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: LAURA GUSTAFSON
  • NPI Number: 1003970930
  • Taxonomy: 111N00000X - Chiropractor

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CLIA Record

Field Name Field Value
CLIA Number 03D2078474
LAB Type Practitioner Other
Facility Name KINGMAN CHIROPACTIC CLINIC
Street 1910 LUCILLE AVE
City KINGMAN
State AZ
ZIP 86401
Phone 928 753-2047
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/29/2024
Certificate Expiration Date 5/28/2026
Facility Type Practitioner Other
Lab Director LAURA GUSTAFSON

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This page was last updated on: 9/29/2025