Provider Demographics
NPI:1124787940
Name:THERAPEUTIC SPINE AND PAIN CENTER, LTD.
Entity type:Organization
Organization Name:THERAPEUTIC SPINE AND PAIN CENTER, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:W
Authorized Official - Last Name:CARMICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-824-8670
Mailing Address - Street 1:19646 BRIAR DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61705-4030
Mailing Address - Country:US
Mailing Address - Phone:309-824-8670
Mailing Address - Fax:
Practice Address - Street 1:3801 GENERAL ELECTRIC RD STE 4
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-4193
Practice Address - Country:US
Practice Address - Phone:309-319-2341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-09
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty