Provider Demographics
NPI:1821573650
Name:INTEGRATIVE PAIN MANAGEMENT CENTER PLLC
Entity Type:Organization
Organization Name:INTEGRATIVE PAIN MANAGEMENT CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:RAKOVCHIK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:214-221-2580
Mailing Address - Street 1:7920 BELT LINE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-8148
Mailing Address - Country:US
Mailing Address - Phone:214-221-2580
Mailing Address - Fax:214-446-2323
Practice Address - Street 1:7920 BELT LINE RD STE 120
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-8148
Practice Address - Country:US
Practice Address - Phone:214-221-2580
Practice Address - Fax:214-446-2323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-27
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty