Provider Demographics
NPI:1154544617
Name:PRECISION SPINAL CARE PLLC
Entity type:Organization
Organization Name:PRECISION SPINAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:THERRIAULT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:928-442-0202
Mailing Address - Street 1:3733 KARICIO LN
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-6829
Mailing Address - Country:US
Mailing Address - Phone:928-442-0202
Mailing Address - Fax:928-776-8858
Practice Address - Street 1:3733 KARICIO LN
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-6829
Practice Address - Country:US
Practice Address - Phone:928-442-0202
Practice Address - Fax:928-776-8858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8023 & 8024111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ115695Medicare PIN