Provider Demographics
NPI:1871680009
Name:TROY PAIN RELIEF CENTER LTD
Entity Type:Organization
Organization Name:TROY PAIN RELIEF CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-667-0600
Mailing Address - Street 1:PO BOX 360
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:IL
Mailing Address - Zip Code:62294-0360
Mailing Address - Country:US
Mailing Address - Phone:618-667-0600
Mailing Address - Fax:618-667-8189
Practice Address - Street 1:805 LIONS DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:IL
Practice Address - Zip Code:62294-2440
Practice Address - Country:US
Practice Address - Phone:618-667-0600
Practice Address - Fax:618-667-8189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-007911111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208469OtherPTAN
IL208469OtherPTAN