Provider Demographics
NPI:1629220066
Name:PIONEER PAIN CENTER, LLC
Entity Type:Organization
Organization Name:PIONEER PAIN CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:KOREEN
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-683-6784
Mailing Address - Street 1:2301 W PARKER RD
Mailing Address - Street 2:STE 3
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-7877
Mailing Address - Country:US
Mailing Address - Phone:214-862-5581
Mailing Address - Fax:972-596-0066
Practice Address - Street 1:2301 W PARKER RD
Practice Address - Street 2:STE 3
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-7877
Practice Address - Country:US
Practice Address - Phone:214-862-5581
Practice Address - Fax:972-596-0066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC4273TX111N00000X
261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPainGroup - Multi-Specialty