Healthcare Provider Details

I. General information

NPI: 1851765804
Provider Name (Legal Business Name): ADVANCED PAIN & BACK INSTITUTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2015
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5425 W BELMONT AVE
CHICAGO IL
60641-4127
US

IV. Provider business mailing address

5425 W BELMONT AVE
CHICAGO IL
60641-4127
US

V. Phone/Fax

Practice location:
  • Phone: 312-702-1313
  • Fax: 844-269-6602
Mailing address:
  • Phone: 312-702-1313
  • Fax: 844-269-6602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number036130509
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State

VIII. Authorized Official

Name: DR. HONG XUAN VO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 832-348-9475