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General NPI Number Information
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NPI Number | 1407917370
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Entity Type | Organization
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Legal Business Name | WESTERN SPINAL CENTER PLLC
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 11/06/2008
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Provider Practice Location Address
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Address Line | 8751 N 51ST AVE SUITE 124
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City | GLENDALE
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State | AZ
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Zip | 85302
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Country | US
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Telephone | 623-334-9689
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Fax | 623-334-9687
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Provider Business Mailing Address
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Address Line | 8751 N 51ST AVE SUITE 124
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City | GLENDALE
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State | AZ
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Zip | 85302-4945
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Country | US
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Telephone | 623-334-9689
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Fax | 623-334-9687
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Authorized Official
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Title or Position | OWNER MEMBER
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Name | DR. TIM D SIPE
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Credential | DC
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Telephone | 623-334-9689
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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 | 3483
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 7011
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License Number State | AZ
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