Healthcare Provider Details

I. General information

NPI: 1457623787
Provider Name (Legal Business Name): JIN'S PAIN THERAPY CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2012
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 W. 35TH ST
CHICAGO IL
60616
US

IV. Provider business mailing address

735 W. 35TH ST
CHICAGO IL
60616
US

V. Phone/Fax

Practice location:
  • Phone: 773-386-2683
  • Fax: 773-254-8944
Mailing address:
  • Phone: 773-386-2683
  • Fax: 773-254-8944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172P00000X
TaxonomyNaprapath
License Number181-000303
License Number StateIL

VIII. Authorized Official

Name: DR. BAILAN JIN
Title or Position: NAPRAPATH
Credential: D-N
Phone: 773-386-2683