Provider Demographics
NPI:1205494440
Name:INNOVATIVE PAIN AND WELLNESS PLC
Entity type:Organization
Organization Name:INNOVATIVE PAIN AND WELLNESS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MD
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:KARL
Authorized Official - Last Name:OCONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-306-7242
Mailing Address - Street 1:18511 N SCOTTSDALE RD STE 202
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-9694
Mailing Address - Country:US
Mailing Address - Phone:480-306-7242
Mailing Address - Fax:
Practice Address - Street 1:22601 N 19TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-1324
Practice Address - Country:US
Practice Address - Phone:623-231-2443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INNOVATIVE PAIN AND WELLNESS PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-03
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty