Healthcare Provider Details

I. General information

NPI: 1073130431
Provider Name (Legal Business Name): INJURY CLINICS OF ARIZONA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2020
Last Update Date: 07/02/2020
Certification Date: 07/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 E BASELINE RD STE 100
GILBERT AZ
85234-2467
US

IV. Provider business mailing address

1515 N GILBERT RD STE 107-744
GILBERT AZ
85234-2318
US

V. Phone/Fax

Practice location:
  • Phone: 480-304-5152
  • Fax: 480-603-4147
Mailing address:
  • Phone: 480-304-5152
  • Fax: 480-603-4147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. FARID ROOH
Title or Position: MEMBER
Credential: DC
Phone: 480-304-5152