Healthcare Provider Details

I. General information

NPI: 1598914210
Provider Name (Legal Business Name): PAIN AND REHAB CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2008
Last Update Date: 09/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 MARTIN LUTHER KING JR AVE SE STE 106
WASHINGTON DC
20020-7022
US

IV. Provider business mailing address

2041 MARTIN LUTHER KING JR AVE SE STE 106
WASHINGTON DC
20020-7022
US

V. Phone/Fax

Practice location:
  • Phone: 202-610-0260
  • Fax:
Mailing address:
  • Phone: 202-610-0260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH030059
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. NESLY CLERGE
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 202-610-0260