Provider Demographics
NPI: | 1457694499 |
---|---|
Name: | PAIN RELIEF CENTERS, LLC |
Entity Type: | Organization |
Organization Name: | PAIN RELIEF CENTERS, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | MICHAEL |
Authorized Official - Middle Name: | JOSEPH |
Authorized Official - Last Name: | DUSA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DC |
Authorized Official - Phone: | 203-230-8440 |
Mailing Address - Street 1: | 2460 DIXWELL AVENUE |
Mailing Address - Street 2: | UNIT 2A |
Mailing Address - City: | HAMDEN |
Mailing Address - State: | CT |
Mailing Address - Zip Code: | 06514 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 203-230-8440 |
Mailing Address - Fax: | 203-230-8366 |
Practice Address - Street 1: | 2460 DIXWELL AVENUE |
Practice Address - Street 2: | UNIT 2A |
Practice Address - City: | HAMDEN |
Practice Address - State: | CT |
Practice Address - Zip Code: | 06514 |
Practice Address - Country: | US |
Practice Address - Phone: | 203-230-8440 |
Practice Address - Fax: | 203-230-8366 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-03-28 |
Last Update Date: | 2013-03-28 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CT | 001015 | 111N00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 111N00000X | Chiropractic Providers | Chiropractor | Group - Single Specialty |