Provider Demographics
NPI:1255478392
Name:ELGIN PAIN & HEADACHE CENTER, INC.
Entity Type:Organization
Organization Name:ELGIN PAIN & HEADACHE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:NNAEMEKA
Authorized Official - Last Name:ONWUTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-717-4790
Mailing Address - Street 1:1975 LIN LOR LN
Mailing Address - Street 2:SUITE 295
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4902
Mailing Address - Country:US
Mailing Address - Phone:847-717-4790
Mailing Address - Fax:630-762-9195
Practice Address - Street 1:1975 LIN LOR LN
Practice Address - Street 2:SUITE 295
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4902
Practice Address - Country:US
Practice Address - Phone:847-717-4790
Practice Address - Fax:630-762-9195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty