Healthcare Provider Details

I. General information

NPI: 1962642629
Provider Name (Legal Business Name): LASERTECH PAIN RELIEF CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 04/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17606 N. 59TH AVENUE SUITE #3
GLENDALE AZ
85308
US

IV. Provider business mailing address

8575 E SHARON DR
SCOTTSDALE AZ
85260-4139
US

V. Phone/Fax

Practice location:
  • Phone: 602-938-9125
  • Fax: 602-938-9207
Mailing address:
  • Phone: 480-483-1232
  • Fax: 480-483-1232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3789
License Number StateAZ

VIII. Authorized Official

Name: DR. PAUL J. ZLOTO
Title or Position: MANAGER
Credential: D.C.
Phone: 602-938-9125