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General NPI Number Information
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NPI Number | 1396927232
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Entity Type | Organization
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Legal Business Name | THE ULTIMATE SPINE CENTER II, PC
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Dates
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Enumeration Date | 12/03/2007
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Last Update Date | 07/18/2014
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Provider Practice Location Address
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Address Line | 20928 N JOHN WAYNE PKWY SUITE C-4
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City | MARICOPA
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State | AZ
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Zip | 85139-2922
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Country | US
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Telephone | 520-568-9828
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Fax | 520-568-3338
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Provider Business Mailing Address
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Address Line | 2925 E RIGGS RD SUITE 8-137
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City | CHANDLER
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State | AZ
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Zip | 85249-3600
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Country | US
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Telephone | 520-568-9828
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Fax | 520-568-3338
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN D PHAM
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Credential | D.C.
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Telephone | 520-568-9828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 7151
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License Number State | AZ
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