Provider Demographics
NPI: | 1922461912 |
---|---|
Name: | ARIZONA PAIN AND INJURY CENTERS, INC |
Entity Type: | Organization |
Organization Name: | ARIZONA PAIN AND INJURY CENTERS, INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | HAROLD |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | ISEKE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DC |
Authorized Official - Phone: | 323-363-0571 |
Mailing Address - Street 1: | 3140 N 35TH AVE |
Mailing Address - Street 2: | 1 |
Mailing Address - City: | PHOENIX |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85017-5269 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 480-719-0853 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 3140 N 35TH AVE |
Practice Address - Street 2: | 1 |
Practice Address - City: | PHOENIX |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85017-5269 |
Practice Address - Country: | US |
Practice Address - Phone: | 480-719-0853 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-03-29 |
Last Update Date: | 2016-03-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | DC30855 | 111N00000X |
CA | 16440 | 111N00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 111N00000X | Chiropractic Providers | Chiropractor | Group - Multi-Specialty |