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General NPI Number Information
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NPI Number | 1417255621
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Entity Type | Organization
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Legal Business Name | CAREFREE PAIN CLINIC LLC
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Dates
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Enumeration Date | 03/11/2011
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Last Update Date | 03/11/2011
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Provider Practice Location Address
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Address Line | 7208 E. CAVE CREEK RD. SUITE F
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City | CAREFREE
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State | AZ
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Zip | 85377
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Country | US
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Telephone | 480-488-1282
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Fax | 480-488-9040
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Provider Business Mailing Address
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Address Line | PO BOX 232
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City | CAVE CREEK
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State | AZ
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Zip | 85327-0232
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Country | US
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Telephone | 480-488-1282
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Fax | 480-488-9040
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Authorized Official
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Title or Position | OWNER
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Name | JURGEN OLTJENBRUNS
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Credential | D.C.
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Telephone | 480-488-1282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | OTC4954
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License Number State | AZ
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