Healthcare Provider Details

I. General information

NPI: 1700241510
Provider Name (Legal Business Name): ILLINOIS PAIN RELIEF CENTER LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2015
Last Update Date: 12/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1283 W DUNDEE RD
BUFFALO GROVE IL
60089-4009
US

IV. Provider business mailing address

1283 W DUNDEE RD
BUFFALO GROVE IL
60089-4009
US

V. Phone/Fax

Practice location:
  • Phone: 847-632-9919
  • Fax: 773-585-6201
Mailing address:
  • Phone: 847-632-9919
  • Fax: 773-585-6201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number038008505
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number036070333
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number036070333
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070021866
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085004430
License Number StateIL
# 7
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number041142505
License Number StateIL
# 8
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number03607033
License Number StateIL

VIII. Authorized Official

Name: JASON HUI
Title or Position: OWNER
Credential: DC
Phone: 847-632-9919