MEDICARE: DECATUR PAIN CENTER, LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	B845	NV

General Provider Information

NPI Number	:	1740552793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DECATUR PAIN CENTER, LLC.

Provider Business Mailing Address
First Line	:	5288 SPRING MOUNTAIN RD
Second Line	:	STE 200
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-8723
Country	:	US
Telephone Number	:	702-248-1881
Fax Number	:	702-248-3886

Provider Business Practice Location Address
First Line	:	5288 SPRING MOUNTAIN RD
Second Line	:	STE 200
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-8723
Country	:	US
Telephone Number	:	702-248-1881
Fax Number	:	702-248-3886

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JAMES K LO
Credential	:	D.C.
Telephone Number	:	702-248-1881

Provider Enumeration Date	:	02/07/2012
Last Update Date	:	02/07/2012

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Directions to “DECATUR PAIN CENTER, LLC. ” Practice Location

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