Provider Demographics
NPI:1740435866
Name:PRECISION SPINAL FITNESS LLC
Entity type:Organization
Organization Name:PRECISION SPINAL FITNESS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:HENRIKSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-460-1177
Mailing Address - Street 1:1327 E CHANDLER BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-6272
Mailing Address - Country:US
Mailing Address - Phone:480-460-1177
Mailing Address - Fax:480-460-1114
Practice Address - Street 1:1327 E CHANDLER BLVD STE 106
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-6272
Practice Address - Country:US
Practice Address - Phone:480-460-1177
Practice Address - Fax:480-460-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7601111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1952489486OtherTYPE 2