Provider Demographics
NPI:1346296894
Name:THE PAIN & REHABILITATION CLINIC OF CHICAGO
Entity Type:Organization
Organization Name:THE PAIN & REHABILITATION CLINIC OF CHICAGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:E
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:BLONSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-337-6661
Mailing Address - Street 1:640 N LASALLE ST
Mailing Address - Street 2:SUITE 610
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-3781
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:640 N LASALLE ST
Practice Address - Street 2:SUITE 610
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-3781
Practice Address - Country:US
Practice Address - Phone:312-337-6661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001619207OtherBCBS
IL323200Medicare ID - Type Unspecified