Healthcare Provider Details

I. General information

NPI: 1851199277
Provider Name (Legal Business Name): PAIN & SPINE INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 REMINGTON BLVD STE 205
BOLINGBROOK IL
60440-5817
US

IV. Provider business mailing address

329 REMINGTON BLVD STE 205
BOLINGBROOK IL
60440-5817
US

V. Phone/Fax

Practice location:
  • Phone: 815-729-0707
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JIGNESH PATEL
Title or Position: ADMIN
Credential:
Phone: 815-729-0700