Basic Information
| Provider Information | |||||||||
| NPI: | 1700241510 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ILLINOIS PAIN RELIEF CENTER LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1283 W DUNDEE RD | ||||||||
| Address2: | |||||||||
| City: | BUFFALO GROVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600894009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476329919 | ||||||||
| FaxNumber: | 7735856201 | ||||||||
| Practice Location | |||||||||
| Address1: | 1283 W DUNDEE RD | ||||||||
| Address2: | |||||||||
| City: | BUFFALO GROVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600894009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476329919 | ||||||||
| FaxNumber: | 7735856201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2015 | ||||||||
| LastUpdateDate: | 12/21/2015 | ||||||||
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| AuthorizedOfficialLastName: | HUI | ||||||||
| AuthorizedOfficialFirstName: | JASON | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8476329919 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | IL | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 111NR0400X | 038008505 | IL | N | 193200000X MULTI-SPECIALTY GROUP | Chiropractic Providers | Chiropractor | Rehabilitation | 208VP0000X | 036070333 | IL | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 208VP0014X | 036070333 | IL | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 225100000X | 070021866 | IL | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 363A00000X | 085004430 | IL | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363L00000X | 041142505 | IL | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 2081P2900X | 03607033 | IL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
No ID Information.