Healthcare Provider Details

I. General information

NPI: 1871002683
Provider Name (Legal Business Name): VERVE WELLNESS CENTER, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2017
Last Update Date: 07/21/2022
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4838 E BASELINE RD STE 110
MESA AZ
85206-4674
US

IV. Provider business mailing address

4838 E BASELINE RD BUILDING 2, SUITE 110
MESA AZ
85206-4678
US

V. Phone/Fax

Practice location:
  • Phone: 480-969-4040
  • Fax: 480-830-1042
Mailing address:
  • Phone: 480-969-4040
  • Fax: 480-830-1042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID ALEXANDER WARKENTIN
Title or Position: PRESIDENT/CEO
Credential: DC
Phone: 480-969-4040