Provider Demographics
NPI:1710925433
Name:THE PAIN AND REHABILITATION CENTER
Entity Type:Organization
Organization Name:THE PAIN AND REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:THAWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-838-3100
Mailing Address - Street 1:4011 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19802-2219
Mailing Address - Country:US
Mailing Address - Phone:302-762-0200
Mailing Address - Fax:302-762-0500
Practice Address - Street 1:4011 N MARKET ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-2219
Practice Address - Country:US
Practice Address - Phone:302-762-0200
Practice Address - Fax:302-762-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF10000295111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEU44094Medicare UPIN