Provider Demographics
NPI:1841226271
Name:AZ. SPINE & ACUPUNCTURE CENTER LLC
Entity Type:Organization
Organization Name:AZ. SPINE & ACUPUNCTURE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:520-568-5437
Mailing Address - Street 1:P.O. BOX 1307
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85239
Mailing Address - Country:US
Mailing Address - Phone:520-568-5437
Mailing Address - Fax:
Practice Address - Street 1:19428 N. MARICOPA RD.
Practice Address - Street 2:SUITE C1
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85239
Practice Address - Country:US
Practice Address - Phone:520-568-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7586111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty