MEDICARE: SPINALWORKS 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	111N00000X	Chiropractor	7703	AZ

General Provider Information

NPI Number	:	1629092051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPINALWORKS INC

Provider Business Mailing Address
First Line	:	15640 N 7TH ST
Second Line	:	SUITE #A3
City	:	PHOENIX
State	:	AZ
Zip	:	85022-3512
Country	:	US
Telephone Number	:	602-298-1600
Fax Number	:	602-298-6790

Provider Business Practice Location Address
First Line	:	15640 N 7TH ST
Second Line	:	SUITE #A3
City	:	PHOENIX
State	:	AZ
Zip	:	85022-3512
Country	:	US
Telephone Number	:	602-298-1600
Fax Number	:	602-298-6790

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. TRACY STEVEN VAN LAECKEN
Credential	:	D.C
Telephone Number	:	602-370-7405

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	07/15/2015

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Directions to “SPINALWORKS INC ” Practice Location

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