Healthcare Provider Details

I. General information

NPI: 1508137324
Provider Name (Legal Business Name): INFINITY SPINE CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2012
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 S PRICE RD D110
TEMPE AZ
85282-7530
US

IV. Provider business mailing address

3330 S PRICE RD D110
TEMPE AZ
85282-7530
US

V. Phone/Fax

Practice location:
  • Phone: 480-345-2080
  • Fax: 480-345-2199
Mailing address:
  • Phone: 480-345-2080
  • Fax: 480-345-2199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8228
License Number StateAZ

VIII. Authorized Official

Name: DR. JOHN P THOMA
Title or Position: OWNER/CHIROPRACTOR
Credential: DC
Phone: 614-571-5200