Provider Demographics
NPI:1942592043
Name:TEMPE PAIN & INJURY CENTER, LLC
Entity type:Organization
Organization Name:TEMPE PAIN & INJURY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLARDO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:480-779-9334
Mailing Address - Street 1:5623 S BOUNTY CT
Mailing Address - Street 2:UNIT E
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-2033
Mailing Address - Country:US
Mailing Address - Phone:480-203-5632
Mailing Address - Fax:
Practice Address - Street 1:1730 E WARNER RD
Practice Address - Street 2:SUITE 8
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-4543
Practice Address - Country:US
Practice Address - Phone:480-779-9334
Practice Address - Fax:480-897-0222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-06
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7809111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty