Provider Demographics
NPI:1346694676
Name:PAIN MANAGEMENT AND WELLNESS INSTITUTE, PLLC
Entity Type:Organization
Organization Name:PAIN MANAGEMENT AND WELLNESS INSTITUTE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DALLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-265-0890
Mailing Address - Street 1:10810 N TATUM BLVD
Mailing Address - Street 2:SUITE 102-302
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-6055
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10810 N TATUM BLVD
Practice Address - Street 2:SUITE 102-302
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-6055
Practice Address - Country:US
Practice Address - Phone:602-740-1333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-23
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty