Provider Demographics
NPI:1023586617
Name:WINDY CITY PAIN RELIEF, S.C.
Entity type:Organization
Organization Name:WINDY CITY PAIN RELIEF, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER, SHAREHOLDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANELE
Authorized Official - Middle Name:NICHOLE
Authorized Official - Last Name:MCGOWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-560-8061
Mailing Address - Street 1:PO BOX 16008
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-0001
Mailing Address - Country:US
Mailing Address - Phone:708-972-9695
Mailing Address - Fax:708-576-8491
Practice Address - Street 1:5571 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2356
Practice Address - Country:US
Practice Address - Phone:708-972-9695
Practice Address - Fax:708-401-0194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-13
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center