Basic Information
| Provider Information | |||||||||
| NPI: | 1245692581 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INNOVATIVE PAIN & SPINE SPECIALISTS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7121 STEPHANIE LN STE 102 | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685165352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706632742 | ||||||||
| FaxNumber: | 9703422093 | ||||||||
| Practice Location | |||||||||
| Address1: | 7121 STEPHANIE LN STE 102 | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685165359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024135010 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2016 | ||||||||
| LastUpdateDate: | 07/15/2022 | ||||||||
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| AuthorizedOfficialLastName: | CHICOINE | ||||||||
| AuthorizedOfficialFirstName: | KEELI | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 4024135010 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
No ID Information.