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General NPI Number Information
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NPI Number | 1437458536
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Entity Type | Organization
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Legal Business Name | PAIN INSTITUTE, LTD
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Dates
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Enumeration Date | 03/15/2011
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Last Update Date | 08/01/2011
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Provider Practice Location Address
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Address Line | 4972 BENCHMARK CENTRE DR
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City | SWANSEA
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State | IL
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Zip | 62226-2070
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Country | US
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Telephone | 931-905-1720
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Fax | 931-905-1721
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Provider Business Mailing Address
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Address Line | 4972 BENCHMARK CENTRE
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City | SWANSEA
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State | IL
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Zip | 62226-2070
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Country | US
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Telephone | 931-905-1720
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Fax | 931-905-1721
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Authorized Official
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Title or Position | OWNER
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Name | MR. KYLE M LONGO
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Credential | D.C.
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Telephone | 931-905-1720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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