Provider Demographics
NPI:1518346337
Name:CHICAGO PAIN & WELLNESS
Entity Type:Organization
Organization Name:CHICAGO PAIN & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINDALE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-774-8733
Mailing Address - Street 1:110 N PEORIA ST
Mailing Address - Street 2:UNIT 301
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2396
Mailing Address - Country:US
Mailing Address - Phone:847-774-8733
Mailing Address - Fax:312-690-4880
Practice Address - Street 1:110 N PEORIA ST
Practice Address - Street 2:UNIT 301
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2396
Practice Address - Country:US
Practice Address - Phone:847-774-8733
Practice Address - Fax:312-690-4880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011888111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty