Provider Demographics
NPI:1821144791
Name:THE PAIN CLINIC, INC.
Entity Type:Organization
Organization Name:THE PAIN CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROPER
Authorized Official - Middle Name:
Authorized Official - Last Name:DOLLARHIDE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-368-0508
Mailing Address - Street 1:5445 W SAHARA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-0308
Mailing Address - Country:US
Mailing Address - Phone:702-368-0508
Mailing Address - Fax:702-368-2049
Practice Address - Street 1:5445 W SAHARA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-0308
Practice Address - Country:US
Practice Address - Phone:702-368-0508
Practice Address - Fax:702-368-2049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB720111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV33721Medicare ID - Type UnspecifiedINDIVIDUAL
NVU69653Medicare UPIN
NVV33720Medicare ID - Type UnspecifiedGROUP I.D.