MEDICARE: ADVANCED SPINE AND REHAB PC

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	363LF0000X	Family Nurse Practitioner
2	111N00000X	Chiropractor	5447	AZ
3	111N00000X	Chiropractor	5639	AZ

General Provider Information

NPI Number	:	1922020858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED SPINE AND REHAB PC

Provider Business Mailing Address
First Line	:	4540 E BASELINE RD STE 111
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-4616
Country	:	US
Telephone Number	:	480-892-1122
Fax Number	:	480-892-2243

Provider Business Practice Location Address
First Line	:	4540 E BASELINE RD STE 111
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-4616
Country	:	US
Telephone Number	:	480-892-1122
Fax Number	:	480-892-2243

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. MICHAEL DAVID CRISMON
Credential	:	DC
Telephone Number	:	480-892-1122

Provider Enumeration Date	:	07/23/2006
Last Update Date	:	12/17/2025

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Directions to “ADVANCED SPINE AND REHAB PC ” Practice Location

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