=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124192315
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TMT SOUTHWEST INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2006
-----------------------------------------------------
Last Update Date | 09/13/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13470 N 83RD AVE SUITE 302
-----------------------------------------------------
City | PEORIA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85381
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-773-0300
-----------------------------------------------------
Fax | 623-773-0200
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13470 N 83RD AVE SUITE 302
-----------------------------------------------------
City | PEORIA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85381
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-773-0300
-----------------------------------------------------
Fax | 623-773-0200
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR OWNER
-----------------------------------------------------
Name | DR. THOMAS MICHAEL TRAINA
-----------------------------------------------------
Credential | DC CCSP
-----------------------------------------------------
Telephone | 623-773-0300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 5150
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------