Healthcare Provider Details

I. General information

NPI: 1427254184
Provider Name (Legal Business Name): FAMILY STRESS AND PAIN CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N MICHIGAN AVE #1729
CHICAGO IL
60602-3402
US

IV. Provider business mailing address

2800 N LAKE SHORE DR #2215
CHICAGO IL
60657-6232
US

V. Phone/Fax

Practice location:
  • Phone: 773-935-3500
  • Fax: 773-472-1022
Mailing address:
  • Phone: 773-935-3500
  • Fax: 773-472-1022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149000523
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code172P00000X
TaxonomyNaprapath
License Number181000295
License Number StateIL

VIII. Authorized Official

Name: DR. CLIFFORD BRICKMAN
Title or Position: DIRECTOR DOCTOR OF NAPR MEDICINE
Credential: DN AM DCSW LCSW
Phone: 773-935-3500