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General NPI Number Information
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NPI Number | 1689140741
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Entity Type | Organization
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Legal Business Name | PRISM PAIN AND SPINE, INC
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Dates
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Enumeration Date | 10/16/2018
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Last Update Date | 10/16/2018
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Provider Practice Location Address
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Address Line | 3838 SAN DIMAS, STE. 3838 SAN DIMAS,STE. B-231
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City | BAKERSFIELD
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State | CA
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Zip | 93301
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Country | US
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Telephone | 661-665-0505
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Fax | 661-665-7844
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Provider Business Mailing Address
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Address Line | 3838 SAN DIMAS, STE.B-231
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City | BAKERSFIELD
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State | CA
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Zip | 93301
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Country | US
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Telephone | 661-665-0505
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Fax | 661-665-7844
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DANIEL KRAUCHUK
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Credential | D.O.
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Telephone | 661-665-0505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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