Healthcare Provider Details

I. General information

NPI: 1982240917
Provider Name (Legal Business Name): ADVANCED PAIN MANAGEMENT OF ELWOOD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7408 W STATE ROAD 28
ELWOOD IN
46036-8600
US

IV. Provider business mailing address

7408 W STATE ROAD 28
ELWOOD IN
46036-8600
US

V. Phone/Fax

Practice location:
  • Phone: 765-557-8569
  • Fax: 765-557-8635
Mailing address:
  • Phone: 765-557-8569
  • Fax: 765-557-8635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DAVID DUNHAM
Title or Position: OWNER
Credential: NP, DPT, DC
Phone: 765-557-8569