Healthcare Provider Details

I. General information

NPI: 1164150876
Provider Name (Legal Business Name): FIX MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11333 N SCOTTSDALE RD STE 140
SCOTTSDALE AZ
85254-5190
US

IV. Provider business mailing address

5030 CAMINO DE LA SIESTA STE 404
SAN DIEGO CA
92108-3120
US

V. Phone/Fax

Practice location:
  • Phone: 619-295-9791
  • Fax: 619-297-6901
Mailing address:
  • Phone: 858-248-5060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JESIKA CASEY
Title or Position: CASE MANAGER
Credential:
Phone: 858-248-5060