Healthcare Provider Details

I. General information

NPI: 1083557243
Provider Name (Legal Business Name): PRESSCOTT PAIN CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 E JACQUE DR
PRESCOTT VALLEY AZ
86314-6172
US

IV. Provider business mailing address

1590 WILLOW CREEK RD
PRESCOTT AZ
86301-1164
US

V. Phone/Fax

Practice location:
  • Phone: 928-277-8715
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN WOJCIAK
Title or Position: MEMBER
Credential:
Phone: 928-699-1246