Provider Demographics
NPI:1720837180
Name:INTEGRATED PAIN MANAGEMENT SC
Entity type:Organization
Organization Name:INTEGRATED PAIN MANAGEMENT SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:XIA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:312-842-4588
Mailing Address - Street 1:244 E ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4647
Mailing Address - Country:US
Mailing Address - Phone:312-845-4588
Mailing Address - Fax:
Practice Address - Street 1:810 S MCLEAN BLVD
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-6703
Practice Address - Country:US
Practice Address - Phone:630-629-6298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTEGRATED PAIN MANAGEMENT, SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No332900000XSuppliersNon-Pharmacy Dispensing Site