Healthcare Provider Details

I. General information

NPI: 1255478392
Provider Name (Legal Business Name): ELGIN PAIN & HEADACHE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 LIN LOR LN SUITE 295
ELGIN IL
60123-4902
US

IV. Provider business mailing address

1975 LIN LOR LN SUITE 295
ELGIN IL
60123-4902
US

V. Phone/Fax

Practice location:
  • Phone: 847-717-4790
  • Fax: 630-762-9195
Mailing address:
  • Phone: 847-717-4790
  • Fax: 630-762-9195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: J NNAEMEKA ONWUTA
Title or Position: AUTHORIZED REPRESENTATIVE
Credential: MD
Phone: 847-717-4790