MEDICARE: INFINITY PAIN RELIEF, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1346867488
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INFINITY PAIN RELIEF, LLC

Provider Business Mailing Address
First Line	:	8715 W UNION HILLS DR STE 109
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-3031
Country	:	US
Telephone Number	:	623-440-4244
Fax Number	:

Provider Business Practice Location Address
First Line	:	8715 W UNION HILLS DR STE 109
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-3031
Country	:	US
Telephone Number	:	623-440-4244
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BRANDON GEOFFREY KULP
Credential	:	DC
Telephone Number	:	623-440-4244

Provider Enumeration Date	:	07/05/2020
Last Update Date	:	07/05/2020

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