Provider Demographics
NPI:1659357135
Name:PAINLESS SPINE CENTER INC
Entity Type:Organization
Organization Name:PAINLESS SPINE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:AYA
Authorized Official - Last Name:OTIKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-486-3555
Mailing Address - Street 1:23110 ATLANTIC CIR
Mailing Address - Street 2:#F
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-5920
Mailing Address - Country:US
Mailing Address - Phone:951-486-3555
Mailing Address - Fax:951-486-3556
Practice Address - Street 1:23110 ATLANTIC CIR
Practice Address - Street 2:#F
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-5920
Practice Address - Country:US
Practice Address - Phone:951-486-3555
Practice Address - Fax:951-486-3556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39449225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ01789ZMedicare ID - Type Unspecified