Provider Demographics
NPI:1326818360
Name:AXIS SPINE LLC
Entity Type:Organization
Organization Name:AXIS SPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DYLAN
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-277-0578
Mailing Address - Street 1:2155 E UNIVERSITY DR STE 110
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85288-4685
Mailing Address - Country:US
Mailing Address - Phone:480-454-4776
Mailing Address - Fax:
Practice Address - Street 1:2155 E UNIVERSITY DR STE 110
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85288-4685
Practice Address - Country:US
Practice Address - Phone:480-454-4776
Practice Address - Fax:480-454-4776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty