Provider Demographics
NPI:1770823197
Name:MUSCLE PAIN CLINIC INC
Entity Type:Organization
Organization Name:MUSCLE PAIN CLINIC INC
Other - Org Name:ILLINOIS VALLEY CHRONIC CONDITIONS & ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILL
Authorized Official - Middle Name:TO
Authorized Official - Last Name:ZUHIRA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-410-4004
Mailing Address - Street 1:4231 PROGRESS BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IL
Mailing Address - Zip Code:61354-1193
Mailing Address - Country:US
Mailing Address - Phone:815-410-4004
Mailing Address - Fax:815-410-4006
Practice Address - Street 1:4231 PROGRESS BLVD STE 4
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IL
Practice Address - Zip Code:61354
Practice Address - Country:US
Practice Address - Phone:815-410-4004
Practice Address - Fax:815-410-4006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010923111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty