Provider Demographics
NPI:1407090350
Name:THE PAIN CLINIC INC.
Entity Type:Organization
Organization Name:THE PAIN CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-474-2700
Mailing Address - Street 1:3674 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-3144
Mailing Address - Country:US
Mailing Address - Phone:708-474-2700
Mailing Address - Fax:708-474-3300
Practice Address - Street 1:3674 RIDGE RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-3144
Practice Address - Country:US
Practice Address - Phone:708-474-2700
Practice Address - Fax:708-474-3300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-006292111N00000X
IL036-063384204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty