Provider Demographics
NPI:1194973453
Name:ARIZONA SPORTS AND SPINE PHYSICIANS, P.C.
Entity type:Organization
Organization Name:ARIZONA SPORTS AND SPINE PHYSICIANS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:CHAROCHAK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:602-375-3333
Mailing Address - Street 1:3033 W BELL RD # 101A
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-3000
Mailing Address - Country:US
Mailing Address - Phone:602-375-3333
Mailing Address - Fax:602-375-0435
Practice Address - Street 1:3033 W BELL RD # 101A
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-3000
Practice Address - Country:US
Practice Address - Phone:602-375-3333
Practice Address - Fax:602-375-0435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2333261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service