Healthcare Provider Details

I. General information

NPI: 1023219508
Provider Name (Legal Business Name): INTEGRATED PAIN RELIEF, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 02/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4161 S EASTERN AVE STE A9
LAS VEGAS NV
89119-5425
US

IV. Provider business mailing address

4161 S EASTERN AVE STE A9
LAS VEGAS NV
89119-5425
US

V. Phone/Fax

Practice location:
  • Phone: 702-948-2520
  • Fax: 702-948-2523
Mailing address:
  • Phone: 702-948-2520
  • Fax: 702-948-2523

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: JON PETRICK
Title or Position: PRESIDENT & CEO
Credential: DC
Phone: 702-948-2520