Healthcare Provider Details

I. General information

NPI: 1619216348
Provider Name (Legal Business Name): INTEGRATED PAIN SOLUTIONS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2013
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 N ANDERSON ST SUITE 4
ELWOOD IN
46036-1293
US

IV. Provider business mailing address

517 N ANDERSON ST SUITE 4
ELWOOD IN
46036-1293
US

V. Phone/Fax

Practice location:
  • Phone: 317-577-1990
  • Fax: 317-577-1993
Mailing address:
  • Phone: 317-577-1990
  • Fax: 317-577-1993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08002002A
License Number StateIN

VIII. Authorized Official

Name: DR. MATTHEW J BAUER
Title or Position: PRESIDENT
Credential: D.C.
Phone: 317-577-1990