Provider Demographics
NPI:1881081420
Name:NORTHWEST PAIN MANAGEMENT CENTER LTD
Entity type:Organization
Organization Name:NORTHWEST PAIN MANAGEMENT CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CRANE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-893-6815
Mailing Address - Street 1:405 E CONGRESS PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-6229
Mailing Address - Country:US
Mailing Address - Phone:818-893-6815
Mailing Address - Fax:815-687-8684
Practice Address - Street 1:405 E CONGRESS PKWY STE C
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-6229
Practice Address - Country:US
Practice Address - Phone:818-893-6815
Practice Address - Fax:815-687-8684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042620424111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty