Organization
ADVANCED SPINE AND PAIN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JARRETT MICHAEL LEATHEM (DO OWNER)
(860) 670-2412
Entity
Organization
Contact information
Practice address
9949 W BELL RD STE 100, SUN CITY, AZ 85351-1200
(480) 573-0130
Mailing address
PO BOX 29901 DEPT ID 976, PHOENIX, AZ 85038-0901
(480) 573-0130
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
Other
Enumeration date
02/06/2023
Last updated
02/06/2023
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