Healthcare Provider Details

I. General information

NPI: 1548290521
Provider Name (Legal Business Name): ADVANCED CENTER FOR PAIN AND REHAB SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 W WASHINGTON ST
SPRINGFIELD IL
62702-6630
US

IV. Provider business mailing address

2060 W WASHINGTON ST
SPRINGFIELD IL
62702-6630
US

V. Phone/Fax

Practice location:
  • Phone: 217-787-8200
  • Fax: 217-787-8899
Mailing address:
  • Phone: 217-787-8200
  • Fax: 217-787-8899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: PAUL R VENTURINI
Title or Position: MANAGER OWNER
Credential: DO
Phone: 217-787-8200