Healthcare Provider Details

I. General information

NPI: 1205292315
Provider Name (Legal Business Name): ADVANCED BACK AND NECK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2016
Last Update Date: 03/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 W QUEEN CREEK RD STE 3
CHANDLER AZ
85248-8134
US

IV. Provider business mailing address

1055 W QUEEN CREEK RD STE 3
CHANDLER AZ
85248-8134
US

V. Phone/Fax

Practice location:
  • Phone: 480-814-7115
  • Fax: 480-814-7792
Mailing address:
  • Phone: 480-814-7115
  • Fax: 480-814-7792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8194
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number32912
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8894
License Number StateAZ

VIII. Authorized Official

Name: DAVID A VOYER
Title or Position: PRESIDENT
Credential: D.C.
Phone: 480-299-5700