MEDICARE: ARIZONA DISC AND SPINE CENTER LLC

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	5541	AZ

General Provider Information

NPI Number	:	1720279854
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARIZONA DISC AND SPINE CENTER LLC

Provider Business Mailing Address
First Line	:	3305 E GREENWAY RD
Second Line	:	#7
City	:	PHOENIX
State	:	AZ
Zip	:	85032-4509
Country	:	US
Telephone Number	:	602-787-9511
Fax Number	:

Provider Business Practice Location Address
First Line	:	3305 E GREENWAY RD
Second Line	:	#7
City	:	PHOENIX
State	:	AZ
Zip	:	85032-4509
Country	:	US
Telephone Number	:	602-787-9511
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. ADAM B WAGNER
Credential	:	D.C.
Telephone Number	:	602-787-9511

Provider Enumeration Date	:	08/05/2007
Last Update Date	:	01/10/2008

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