Healthcare Provider Details

I. General information

NPI: 1619547031
Provider Name (Legal Business Name): INJURY PAIN GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E WARNER RD STE 107
TEMPE AZ
85284-3224
US

IV. Provider business mailing address

PO BOX 11180
TEMPE AZ
85284-0020
US

V. Phone/Fax

Practice location:
  • Phone: 480-897-3300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. KRISTY MORGAN
Title or Position: OWNER
Credential: DO
Phone: 623-935-9920