Healthcare Provider Details

I. General information

NPI: 1154066942
Provider Name (Legal Business Name): PRECISION PAIN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2022
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 HARVARD CIR STE 700
WEST PALM BEACH FL
33409-1989
US

IV. Provider business mailing address

1470-A ROYAL PALM BEACH BLVD
ROYAL PALM BEACH FL
33411
US

V. Phone/Fax

Practice location:
  • Phone: 561-422-1819
  • Fax:
Mailing address:
  • Phone: 561-422-1819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY DECANIO
Title or Position: OWNER
Credential: DC
Phone: 561-422-1819