Provider Demographics
NPI:1558695916
Name:CHICAGOLAND ADVANCED PAIN CENTER
Entity Type:Organization
Organization Name:CHICAGOLAND ADVANCED PAIN CENTER
Other - Org Name:PAIN AND SPINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-632-5600
Mailing Address - Street 1:10330 W ROOSEVELT RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-2571
Mailing Address - Country:US
Mailing Address - Phone:708-632-5600
Mailing Address - Fax:
Practice Address - Street 1:700 E OGDEN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-5569
Practice Address - Country:US
Practice Address - Phone:708-632-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-01
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain