Basic Information
| Provider Information | |||||||||
| NPI: | 1538560446 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SCOTTSDALE PAIN-X PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 11180 | ||||||||
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| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852840020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802643744 | ||||||||
| FaxNumber: | 4802642075 | ||||||||
| Practice Location | |||||||||
| Address1: | 21050 N TATUM BLVD | ||||||||
| Address2: | SUITE 114 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850504260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805857463 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2014 | ||||||||
| LastUpdateDate: | 09/10/2014 | ||||||||
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| AuthorizedOfficialLastName: | WIEGAND | ||||||||
| AuthorizedOfficialFirstName: | AARON | ||||||||
| AuthorizedOfficialMiddleName: | LAWRENCE | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIROPRACTOR | ||||||||
| AuthorizedOfficialTelephone: | 4805857463 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 364SF0001X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Family Health | 2081P2900X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
No ID Information.