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General NPI Number Information
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NPI Number | 1285600247
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Entity Type | Organization
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Legal Business Name | BACK PAIN CENTER, INC.
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Dates
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Enumeration Date | 02/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2516 MASCOUTAH AVE
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City | BELLEVILLE
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State | IL
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Zip | 62220-3468
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Country | US
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Telephone | 618-233-4200
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Fax | 618-233-3428
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Provider Business Mailing Address
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Address Line | 2516 MASCOUTAH AVE
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City | BELLEVILLE
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State | IL
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Zip | 62220-3468
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Country | US
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Telephone | 618-233-4200
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Fax | 618-233-3428
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Authorized Official
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Title or Position | OWNER
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Name | DR. JASON CHRISTOPHER WALKER
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Credential | D.C.
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Telephone | 618-233-4200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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