Healthcare Provider Details

I. General information

NPI: 1588814842
Provider Name (Legal Business Name): ARIZONA SPINE AND SPORTS MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17606 N 17TH PL UNIT 1010
PHOENIX AZ
85022-2136
US

IV. Provider business mailing address

17606 N 17TH PL UNIT 1010
PHOENIX AZ
85022-2136
US

V. Phone/Fax

Practice location:
  • Phone: 480-390-8188
  • Fax:
Mailing address:
  • Phone: 480-390-8188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number7379
License Number StateAZ

VIII. Authorized Official

Name: DR. MICHAEL JOSEPH JAREMBEK
Title or Position: PRESIDENT/CEO
Credential: DC
Phone: 480-390-8188