Provider Demographics
NPI:1740552793
Name:DECATUR PAIN CENTER, LLC.
Entity type:Organization
Organization Name:DECATUR PAIN CENTER, LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:K
Authorized Official - Last Name:LO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-248-1881
Mailing Address - Street 1:5288 SPRING MOUNTAIN RD
Mailing Address - Street 2:STE 200
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-8723
Mailing Address - Country:US
Mailing Address - Phone:702-248-1881
Mailing Address - Fax:702-248-3886
Practice Address - Street 1:5288 SPRING MOUNTAIN RD
Practice Address - Street 2:STE 200
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-8723
Practice Address - Country:US
Practice Address - Phone:702-248-1881
Practice Address - Fax:702-248-3886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB845111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty