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General NPI Number Information
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NPI Number | 1982896023
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Entity Type | Organization
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Legal Business Name | PREFERRED PAIN CARE SPECIALISTS
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Dates
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Enumeration Date | 08/13/2007
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Last Update Date | 08/13/2007
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Provider Practice Location Address
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Address Line | 4200 W 63RD ST
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City | CHICAGO
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State | IL
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Zip | 60629-5010
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Country | US
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Telephone | 773-936-0303
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Fax | 773-581-5661
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Provider Business Mailing Address
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Address Line | 200 E CHICAGO AVE
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City | WESTMONT
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State | IL
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Zip | 60559-1746
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Country | US
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Telephone | 773-936-0303
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Fax | 773-581-5661
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT E BUTT
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Credential | D.C.
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Telephone | 773-936-0303
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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 | IL
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Taxonomy #2
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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 | IL
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