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General NPI Number Information
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NPI Number | 1740435866
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Entity Type | Organization
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Legal Business Name | PRECISION SPINAL FITNESS LLC
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Dates
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Enumeration Date | 11/18/2008
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Last Update Date | 11/18/2008
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Provider Practice Location Address
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Address Line | 1327 E CHANDLER BLVD STE 106
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City | PHOENIX
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State | AZ
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Zip | 85048-6272
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Country | US
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Telephone | 480-460-1177
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Fax | 480-460-1114
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Provider Business Mailing Address
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Address Line | 1327 E CHANDLER BLVD STE 106
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City | PHOENIX
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State | AZ
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Zip | 85048-6272
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Country | US
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Telephone | 480-460-1177
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Fax | 480-460-1114
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Authorized Official
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Title or Position | OWNER
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Name | MR. MICHAEL ALAN HENRIKSEN
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Credential | DC
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Telephone | 480-460-1177
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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 | 7601
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License Number State | AZ
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