Provider Demographics
NPI:1619216348
Name:INTEGRATED PAIN SOLUTIONS, INC
Entity Type:Organization
Organization Name:INTEGRATED PAIN SOLUTIONS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-577-1990
Mailing Address - Street 1:517 N ANDERSON ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ELWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46036-1293
Mailing Address - Country:US
Mailing Address - Phone:317-577-1990
Mailing Address - Fax:317-577-1993
Practice Address - Street 1:517 N ANDERSON ST
Practice Address - Street 2:SUITE 4
Practice Address - City:ELWOOD
Practice Address - State:IN
Practice Address - Zip Code:46036-1293
Practice Address - Country:US
Practice Address - Phone:317-577-1990
Practice Address - Fax:317-577-1993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002002A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty