Healthcare Provider Details

I. General information

NPI: 1689083446
Provider Name (Legal Business Name): PAIN 2 PERFORMANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 08/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9343 E SHEA BLVD SUITE 125
SCOTTSDALE AZ
85260-6802
US

IV. Provider business mailing address

9343 E SHEA BLVD SUITE 125
SCOTTSDALE AZ
85260-6802
US

V. Phone/Fax

Practice location:
  • Phone: 480-661-1440
  • Fax:
Mailing address:
  • Phone: 480-661-1440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number StateNULL

VIII. Authorized Official

Name: SHARON DISHNER
Title or Position: OWNER
Credential:
Phone: 480-695-5606