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General NPI Number Information
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NPI Number | 1932613031
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Entity Type | Organization
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Legal Business Name | ADDISON INTERVENTIONAL PAIN MANAGEMENT
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Dates
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Enumeration Date | 11/28/2017
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Last Update Date | 11/28/2017
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Provider Practice Location Address
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Address Line | 16633 DALLAS PKWY # 125
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City | ADDISON
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State | TX
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Zip | 75001-6816
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Country | US
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Telephone | 872-380-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 16633 DALLAS PKWY # 125
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City | ADDISON
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State | TX
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Zip | 75001-6816
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Country | US
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Telephone | 872-380-0000
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN W EAST
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Credential | DO
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Telephone | 214-505-0833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | K7724
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License Number State | TX
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