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General NPI Number Information
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NPI Number | 1669013249
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Entity Type | Organization
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Legal Business Name | ARIZONA INJURY CENTER PLLC
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Dates
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Enumeration Date | 10/04/2019
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Last Update Date | 10/04/2019
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Provider Practice Location Address
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Address Line | 21582 S ELLSWORTH LOOP RD STE 120
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-7882
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Country | US
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Telephone | 480-987-5091
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Fax |
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Provider Business Mailing Address
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Address Line | 21283 E MISTY LN
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-5064
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Country | US
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Telephone | 480-639-8833
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Fax |
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Authorized Official
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Title or Position | MEMBER MANAGER
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Name | DR. CRAIG PETERSON
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Credential | DC
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Telephone | 480-639-8833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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