MEDICARE: PIONEER PAIN CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP3300X	Pain Clinic/Center
2	111N00000X	Chiropractor	DC4273TX	TX

General Provider Information

NPI Number	:	1629220066
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIONEER PAIN CENTER, LLC

Provider Business Mailing Address
First Line	:	2301 W PARKER RD
Second Line	:	STE 3
City	:	PLANO
State	:	TX
Zip	:	75023-7877
Country	:	US
Telephone Number	:	214-862-5581
Fax Number	:	972-596-0066

Provider Business Practice Location Address
First Line	:	2301 W PARKER RD
Second Line	:	STE 3
City	:	PLANO
State	:	TX
Zip	:	75023-7877
Country	:	US
Telephone Number	:	214-862-5581
Fax Number	:	972-596-0066

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. KELLI KOREEN MOORE
Credential	:
Telephone Number	:	214-683-6784

Provider Enumeration Date	:	10/16/2008
Last Update Date	:	08/09/2010

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Directions to “PIONEER PAIN CENTER, LLC ” Practice Location

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