MEDICARE: SUN VALLEY AFFILIATED BACK CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center	AP1086	AZ
2	363LA2200X	Adult Health Nurse Practitioner	AP1086	AZ

General Provider Information

NPI Number	:	1215940614
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUN VALLEY AFFILIATED BACK CENTER INC

Provider Business Mailing Address
First Line	:	2934 E HALE ST
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85213-5592
Country	:	US
Telephone Number	:	602-769-4982
Fax Number	:	480-855-5756

Provider Business Practice Location Address
First Line	:	1534 E RAY RD
Second Line	:	SUITE 103
City	:	GILBERT
State	:	AZ
Zip	:	85296-4429
Country	:	US
Telephone Number	:	480-963-3608
Fax Number	:	480-855-5756

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. TERRY LYNN GRAUL
Credential	:	NP-C
Telephone Number	:	480-963-3608

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	09/11/2025

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