Healthcare Provider Details

I. General information

NPI: 1447462155
Provider Name (Legal Business Name): J C PAIN CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N SUPERIOR ST 004
TOLEDO OH
43604-2157
US

IV. Provider business mailing address

1500 N SUPERIOR ST 004
TOLEDO OH
43604-2157
US

V. Phone/Fax

Practice location:
  • Phone: 419-729-8162
  • Fax: 419-729-8164
Mailing address:
  • Phone: 419-729-8162
  • Fax: 419-729-8164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number35046488
License Number StateOH

VIII. Authorized Official

Name: DR. JAMES C CHANG
Title or Position: SOLE PROVIDER
Credential: M.D.
Phone: 419-729-8162