Provider Demographics
NPI:1659812444
Name:INNOVATIVE PAIN AND WELLNESS PLC
Entity Type:Organization
Organization Name:INNOVATIVE PAIN AND WELLNESS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-458-7962
Mailing Address - Street 1:18511 N SCOTTSDALE ROAD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-9677
Mailing Address - Country:US
Mailing Address - Phone:480-306-7242
Mailing Address - Fax:480-306-6246
Practice Address - Street 1:18511 N SCOTTSDALE ROAD
Practice Address - Street 2:SUITE 202
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-9677
Practice Address - Country:US
Practice Address - Phone:480-306-7242
Practice Address - Fax:480-306-6246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-14
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Multi-Specialty