Provider Demographics
NPI:1437627080
Name:ADVANCED SPINE AND PAIN PLLC
Entity Type:Organization
Organization Name:ADVANCED SPINE AND PAIN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOYAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-989-8660
Mailing Address - Street 1:96 E KIMBALLS LN STE 408
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-5021
Mailing Address - Country:US
Mailing Address - Phone:801-572-1186
Mailing Address - Fax:
Practice Address - Street 1:96 E KIMBALLS LN STE 408
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-5021
Practice Address - Country:US
Practice Address - Phone:801-572-1186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-12
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty