MEDICARE: ARIZONA SPINE AND SPORTS MEDICINE, PLLC

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	111NS0005X	Sports Physician Chiropractor	7379	AZ

General Provider Information

NPI Number	:	1588814842
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARIZONA SPINE AND SPORTS MEDICINE, PLLC

Provider Business Mailing Address
First Line	:	17606 N 17TH PL
Second Line	:	UNIT 1010
City	:	PHOENIX
State	:	AZ
Zip	:	85022-2136
Country	:	US
Telephone Number	:	480-390-8188
Fax Number	:

Provider Business Practice Location Address
First Line	:	17606 N 17TH PL
Second Line	:	UNIT 1010
City	:	PHOENIX
State	:	AZ
Zip	:	85022-2136
Country	:	US
Telephone Number	:	480-390-8188
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	DR. MICHAEL JOSEPH JAREMBEK
Credential	:	DC
Telephone Number	:	480-390-8188

Provider Enumeration Date	:	09/23/2008
Last Update Date	:	09/23/2008

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