Healthcare Provider Details

I. General information

NPI: 1942627849
Provider Name (Legal Business Name): PREMIER PAIN SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 03/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2813 E CAMELBACK RD STE 430
PHOENIX AZ
85016-4337
US

IV. Provider business mailing address

PO BOX 268938
OKLAHOMA CITY OK
73126-8938
US

V. Phone/Fax

Practice location:
  • Phone: 602-354-5659
  • Fax: 602-354-5896
Mailing address:
  • Phone: 602-354-5659
  • Fax: 602-354-5896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: VICKI BELT
Title or Position: OWNER
Credential:
Phone: 60235454659