# CANYON PAIN AND SPINE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518547769
- **Authorized official:** KIRK BOWDEN (OWNER)
- **Authorized official phone:** (937) 206-0377

## Contact information

- **Practice address:** 10238 E HAMPTON AVE STE 416, MESA, AZ 85209-3320
- **Practice address phone:** (480) 561-5000
- **Mailing address:** 4156 E SIERRA MADRE AVE, GILBERT, AZ 85296-3084

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | — |
| 207L00000X | Anesthesiology Physician | — | — | — |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | — |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | — |
| 208VP0000X | Pain Medicine Physician | — | NULL | Yes |
| 208VP0000X | Pain Medicine Physician | — | — | Yes |
| 208VP0014X | Interventional Pain Medicine Physician | — | NULL | — |
| 208VP0014X | Interventional Pain Medicine Physician | — | — | — |

## Other

- **Enumeration date:** 04/12/2021
- **Last updated:** 12/30/2022