Healthcare Provider Details

I. General information

NPI: 1285923607
Provider Name (Legal Business Name): NORTH COUNTY PAIN RELIEF CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2011
Last Update Date: 08/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7157 N LINDBERGH BLVD
HAZELWOOD MO
63042-2039
US

IV. Provider business mailing address

7157 N LINDBERGH BLVD
HAZELWOOD MO
63042-2039
US

V. Phone/Fax

Practice location:
  • Phone: 314-731-4201
  • Fax: 314-731-4204
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SHANE CUMMINS
Title or Position: OWNER
Credential:
Phone: 314-731-4201