Provider Demographics
NPI:1639562960
Name:COMPREHENSIVE PAIN AND WELLNESS CENTER, S.C.
Entity Type:Organization
Organization Name:COMPREHENSIVE PAIN AND WELLNESS CENTER, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:LESEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-491-2484
Mailing Address - Street 1:3525 N STATE ROUTE 47
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-8245
Mailing Address - Country:US
Mailing Address - Phone:217-491-2484
Mailing Address - Fax:
Practice Address - Street 1:3525 N STATE ROUTE 47
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-8245
Practice Address - Country:US
Practice Address - Phone:217-491-2484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011590111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty