Healthcare Provider Details

I. General information

NPI: 1538560446
Provider Name (Legal Business Name): SCOTTSDALE PAIN-X PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2014
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21050 N TATUM BLVD SUITE 114
PHOENIX AZ
85050-4260
US

IV. Provider business mailing address

PO BOX 11180
TEMPE AZ
85284-0020
US

V. Phone/Fax

Practice location:
  • Phone: 480-585-7463
  • Fax:
Mailing address:
  • Phone: 480-264-3744
  • Fax: 480-264-2075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AARON LAWRENCE WIEGAND
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 480-585-7463