Healthcare Provider Details

I. General information

NPI: 1316286677
Provider Name (Legal Business Name): THE PAIN RELIEF CLINIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2013
Last Update Date: 02/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 DEXTER COURT SUITE 105
DAVENPORT IA
52807
US

IV. Provider business mailing address

PO BOX 2441
DAVENPORT IA
52809-2441
US

V. Phone/Fax

Practice location:
  • Phone: 563-594-9833
  • Fax: 563-324-8486
Mailing address:
  • Phone: 563-323-4329
  • Fax: 563-324-8486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number28552
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL A. SWANSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 563-594-9833