Healthcare Provider Details

I. General information

NPI: 1932519048
Provider Name (Legal Business Name): SPINEFIT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 E BELL RD STE 152 BLDG 6
PHOENIX AZ
85032-9306
US

IV. Provider business mailing address

4727 E BELL RD STE 45-137
PHOENIX AZ
85032-2308
US

V. Phone/Fax

Practice location:
  • Phone: 602-258-9663
  • Fax: 602-258-9664
Mailing address:
  • Phone: 480-298-9956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7860
License Number StateAZ

VIII. Authorized Official

Name: DR. DANE KOHL
Title or Position: OWNER
Credential: D.C.
Phone: 480-298-9956