Healthcare Provider Details

I. General information

NPI: 1225585292
Provider Name (Legal Business Name): PAIN RELIEF CENTER OF DENNIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 ROUTE 134 SUITE 3
S DENNIS MA
02660
US

IV. Provider business mailing address

24 ROUTE 134 SUITE 3
S DENNIS MA
02660
US

V. Phone/Fax

Practice location:
  • Phone: 508-394-4847
  • Fax:
Mailing address:
  • Phone: 508-394-4847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT SPRAGUE
Title or Position: OWNER
Credential: MD
Phone: 508-394-4847