Healthcare Provider Details

I. General information

NPI: 1992304588
Provider Name (Legal Business Name): MIDWEST PAIN TREATMENT CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2020
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3005 S RIVERSIDE DR STE 201
BELOIT WI
53511-1500
US

IV. Provider business mailing address

3005 S RIVERSIDE DR STE 201
BELOIT WI
53511-1500
US

V. Phone/Fax

Practice location:
  • Phone: 608-365-6771
  • Fax: 208-906-2390
Mailing address:
  • Phone: 608-365-6771
  • Fax: 208-906-2390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: LINDA M CHERF
Title or Position: MEMBER
Credential: L.AC
Phone: 608-295-6186