Provider Demographics
NPI:1699374702
Name:VALLEY SPINAL CARE PAIN RELIEF, LLC
Entity Type:Organization
Organization Name:VALLEY SPINAL CARE PAIN RELIEF, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:KULP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-282-3816
Mailing Address - Street 1:8715 W UNION HILLS DR STE 109
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-3031
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15425 N GREENWAY HAYDEN LOOP STE A200
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1239
Practice Address - Country:US
Practice Address - Phone:602-282-3816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty