Provider Demographics
NPI:1558478149
Name:DAYTON PAIN AND PREVENTIVE MEDICINE
Entity Type:Organization
Organization Name:DAYTON PAIN AND PREVENTIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD OWNER SOLE PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:III
Authorized Official - Credentials:ND
Authorized Official - Phone:937-277-3442
Mailing Address - Street 1:2595 NEEDMORE RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414
Mailing Address - Country:US
Mailing Address - Phone:937-277-3442
Mailing Address - Fax:937-277-2943
Practice Address - Street 1:2595 NEEDMORE RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414
Practice Address - Country:US
Practice Address - Phone:937-277-3442
Practice Address - Fax:937-277-2943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty