MEDICARE: HIGHLAND PAIN CLINIC PLLC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1912138918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIGHLAND PAIN CLINIC PLLC

Provider Business Mailing Address
First Line	:	2211 E HIGHLAND AVE
Second Line	:	SUITE 110
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4835
Country	:	US
Telephone Number	:	602-955-5170
Fax Number	:	602-955-5173

Provider Business Practice Location Address
First Line	:	2211 E HIGHLAND AVE
Second Line	:	SUITE 110
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4835
Country	:	US
Telephone Number	:	602-955-5170
Fax Number	:	602-955-5173

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WIN EDWARD KRESSEL
Credential	:	DC
Telephone Number	:	602-955-5170

Provider Enumeration Date	:	08/07/2009
Last Update Date	:	08/07/2009

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