Healthcare Provider Details

I. General information

NPI: 1891823852
Provider Name (Legal Business Name): PAIN SOLUTIONS WELLNESS NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 MAIN STREET SUITE 330
NASHUA NH
03060
US

IV. Provider business mailing address

280 MAIN STREET SUITE 330
NASHUA NH
03060
US

V. Phone/Fax

Practice location:
  • Phone: 603-577-3003
  • Fax: 603-577-2243
Mailing address:
  • Phone: 603-577-3003
  • Fax: 603-577-2243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: GARY M JANKO
Title or Position: EXECUTIVE VICE PRESIDENT CHIEF OPER
Credential:
Phone: 603-577-3003