Healthcare Provider Details

I. General information

NPI: 1962295360
Provider Name (Legal Business Name): PAIN & SPINE INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2025
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 W COURT ST STE 100
KANKAKEE IL
60901-3673
US

IV. Provider business mailing address

744 ESSINGTON RD
JOLIET IL
60435-4912
US

V. Phone/Fax

Practice location:
  • Phone: 815-729-0700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JIGNESH PATEL
Title or Position: AUTHORIZE OFFICIAL
Credential:
Phone: 815-729-0700