Provider Demographics
NPI:1598071771
Name:TWIN CITIES PAIN MANAGEMENT PC
Entity Type:Organization
Organization Name:TWIN CITIES PAIN MANAGEMENT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:MANNSCHRECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-758-6132
Mailing Address - Street 1:81 CLAY ST APT 522
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-4120
Mailing Address - Country:US
Mailing Address - Phone:509-758-6132
Mailing Address - Fax:509-751-9726
Practice Address - Street 1:1221 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403-2829
Practice Address - Country:US
Practice Address - Phone:509-758-6132
Practice Address - Fax:509-751-9726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-25
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty