Provider Demographics
NPI:1831536689
Name:SONORA SPINE CARE, LLC
Entity type:Organization
Organization Name:SONORA SPINE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-261-2182
Mailing Address - Street 1:2925 E RIGGS RD
Mailing Address - Street 2:SUITE 8-137
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-3600
Mailing Address - Country:US
Mailing Address - Phone:520-428-4772
Mailing Address - Fax:520-333-3161
Practice Address - Street 1:19428 N JOHN WAYNE PKWY
Practice Address - Street 2:STE. F
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-2850
Practice Address - Country:US
Practice Address - Phone:520-428-4772
Practice Address - Fax:520-333-3161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7151111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty