Provider Demographics
NPI:1225405863
Name:PRO CARE PAIN CLINIC
Entity Type:Organization
Organization Name:PRO CARE PAIN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:YOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-487-1025
Mailing Address - Street 1:621 S VIRGIL AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-4000
Mailing Address - Country:US
Mailing Address - Phone:213-487-1025
Mailing Address - Fax:888-450-1242
Practice Address - Street 1:621 S VIRGIL AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-4000
Practice Address - Country:US
Practice Address - Phone:213-487-1025
Practice Address - Fax:888-450-1242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-31
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC16014171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA08312015926198OtherACUPUNCTURE