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General NPI Number Information
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NPI Number | 1215940614
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Entity Type | Organization
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Legal Business Name | SUN VALLEY AFFILIATED BACK CENTER INC
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1534 E RAY RD SUITE 103
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City | GILBERT
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State | AZ
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Zip | 85296-4429
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Country | US
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Telephone | 480-963-3608
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Fax | 480-855-5756
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Provider Business Mailing Address
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Address Line | 2934 E HALE ST
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City | MESA
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State | AZ
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Zip | 85213-5592
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Country | US
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Telephone | 602-769-4982
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Fax | 480-855-5756
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. TERRY LYNN GRAUL
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Credential | NP-C
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Telephone | 480-963-3608
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | AP1086
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | AP1086
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License Number State | AZ
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