Provider Demographics
NPI:1639645138
Name:MENDING SPOT, PLLC
Entity Type:Organization
Organization Name:MENDING SPOT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:RACITI
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:808-457-5807
Mailing Address - Street 1:8315 E SAN BERNARDO DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-2430
Mailing Address - Country:US
Mailing Address - Phone:808-457-5807
Mailing Address - Fax:480-467-0248
Practice Address - Street 1:3254 E CACTUS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-7233
Practice Address - Country:US
Practice Address - Phone:808-457-5807
Practice Address - Fax:480-467-0248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty