Provider Demographics
NPI:1851658785
Name:CAMELBACK MEDICAL CENTERS PLLC
Entity Type:Organization
Organization Name:CAMELBACK MEDICAL CENTERS PLLC
Other - Org Name:CAMELBACK PAIN CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CORMIER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-945-0008
Mailing Address - Street 1:4432 N MILLER RD STE 102
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-3697
Mailing Address - Country:US
Mailing Address - Phone:480-945-0008
Mailing Address - Fax:480-945-2778
Practice Address - Street 1:4432 N MILLER RD STE 102
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-3697
Practice Address - Country:US
Practice Address - Phone:480-945-0008
Practice Address - Fax:480-945-2778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-17
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty