# PROACTIVE PAIN TREATMENT LLC

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

## Provider details

- **NPI number:** 1730742859
- **Authorized official:** JERRY BUCKNER DC (SOLE MBR)
- **Authorized official phone:** (480) 930-4018

## Contact information

- **Practice address:** 1001 E WARNER RD STE 103, TEMPE, AZ 85284-3224
- **Practice address phone:** (480) 566-9755
- **Practice address fax:** (480) 566-9979
- **Mailing address:** 1001 E WARNER RD STE 103, TEMPE, AZ 85284-3224

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 04/15/2019
- **Last updated:** 04/15/2019