Organization
PANACEA BRAIN AND SPINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHAD HARTLEY MD (OWNER)
(720) 883-1593
Entity
Organization
Contact information
Practice address
72 LAKE HAVASU AVE S STE 102, LAKE HAVASU CITY, AZ 86403-0857
(928) 453-2211
(928) 453-2213
Mailing address
72 LAKE HAVASU AVE S STE 102, LAKE HAVASU CITY, AZ 86403-0857
(928) 453-2211
(928) 453-2219
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
46605
AZ
Other
Enumeration date
01/18/2012
Last updated
06/29/2020
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