Basic Information
| Provider Information | |||||||||
| NPI: | 1437750528 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INNOVATIVE PAIN AND WELLNESS PLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18511 N SCOTTSDALE RD STE 202 | ||||||||
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| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852559694 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803067242 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8110 W UNION HILLS DR STE 320 | ||||||||
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| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853088181 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803067242 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2020 | ||||||||
| LastUpdateDate: | 11/04/2020 | ||||||||
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| AuthorizedOfficialLastName: | OCONNOR | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | KARL | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER, MD | ||||||||
| AuthorizedOfficialTelephone: | 4803067242 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | INNOVATIVE PAIN AND WELLNESS PLC | ||||||||
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| NPICertificationDate: | 11/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | N | 193200000X MULTI-SPECIALTY GROUP | Chiropractic Providers | Chiropractor | 207L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | 2081P2900X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | 208VP0000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 208VP0014X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 225100000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 363A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 208100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.