Provider Demographics
NPI:1225368780
Name:INTEGRATED PAIN SOLUTIONS LLC
Entity Type:Organization
Organization Name:INTEGRATED PAIN SOLUTIONS LLC
Other - Org Name:DRAEGER CHIROPRACTIC & LASER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CURT
Authorized Official - Middle Name:J
Authorized Official - Last Name:DRAEGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-623-2123
Mailing Address - Street 1:2327 NEVA ROAD
Mailing Address - Street 2:
Mailing Address - City:ANTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54409
Mailing Address - Country:US
Mailing Address - Phone:715-623-2123
Mailing Address - Fax:715-623-6556
Practice Address - Street 1:2327 NEVA ROAD
Practice Address - Street 2:
Practice Address - City:ANTIGO
Practice Address - State:WI
Practice Address - Zip Code:54409
Practice Address - Country:US
Practice Address - Phone:715-623-2123
Practice Address - Fax:715-623-6556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2183261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38987100Medicaid
WI38987100Medicaid
WI38987100Medicaid