Provider Demographics
NPI:1023219508
Name:INTEGRATED PAIN RELIEF, LLC
Entity Type:Organization
Organization Name:INTEGRATED PAIN RELIEF, LLC
Other - Org Name:INTEGRATED PAIN RELIEF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-948-2520
Mailing Address - Street 1:4161 S EASTERN AVE STE A9
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5425
Mailing Address - Country:US
Mailing Address - Phone:702-948-2520
Mailing Address - Fax:702-948-2523
Practice Address - Street 1:4161 S EASTERN AVE STE A9
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5425
Practice Address - Country:US
Practice Address - Phone:702-948-2520
Practice Address - Fax:702-948-2523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2008-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV104355Medicare PIN