Provider Demographics
NPI:1487155354
Name:AZ INTEGRATED NEURO SPINE & PAIN LLC
Entity type:Organization
Organization Name:AZ INTEGRATED NEURO SPINE & PAIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MANINDER
Authorized Official - Middle Name:S
Authorized Official - Last Name:KAHLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-322-5700
Mailing Address - Street 1:13640 N 99TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-0001
Mailing Address - Country:US
Mailing Address - Phone:623-322-5700
Mailing Address - Fax:866-540-1170
Practice Address - Street 1:13640 N 99TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-0001
Practice Address - Country:US
Practice Address - Phone:623-322-5700
Practice Address - Fax:866-540-1170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-26
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty