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General NPI Number Information
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NPI Number | 1902323389
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Entity Type | Organization
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Legal Business Name | SPINEWISE LLC
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Dates
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Enumeration Date | 08/25/2017
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Last Update Date | 08/25/2017
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Provider Practice Location Address
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Address Line | 18407 E CATTLE DR
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-5175
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Country | US
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Telephone | 480-444-9036
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Fax |
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Provider Business Mailing Address
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Address Line | 18521 E QUEEN CREEK RD STE 490
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-5866
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | BECKY ROGERS
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Credential |
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Telephone | 480-444-9036
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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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