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General NPI Number Information
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NPI Number | 1508373358
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Entity Type | Organization
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Legal Business Name | 3D INTEGRATED MEDICAL, LLC
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Dates
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Enumeration Date | 01/02/2018
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Last Update Date | 01/02/2018
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Provider Practice Location Address
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Address Line | 2135 E SOUTHERN AVE
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City | TEMPE
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State | AZ
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Zip | 85282-7503
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Country | US
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Telephone | 480-456-3703
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Fax | 480-456-0477
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Provider Business Mailing Address
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Address Line | 2135 E SOUTHERN AVE
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City | TEMPE
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State | AZ
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Zip | 85282-7503
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Country | US
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Telephone | 480-456-3703
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Fax | 480-456-0477
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDWARD TRAUM
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Credential | D.C.
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Telephone | 480-456-3703
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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