Provider Demographics
NPI:1992089247
Name:CHRONIC PAIN DIAGNOSTICS, INC
Entity type:Organization
Organization Name:CHRONIC PAIN DIAGNOSTICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ENGLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-771-8701
Mailing Address - Street 1:125 ALLIMORE CT
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-8853
Mailing Address - Country:US
Mailing Address - Phone:916-771-8701
Mailing Address - Fax:916-771-8710
Practice Address - Street 1:125 ALLIMORE CT
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-8853
Practice Address - Country:US
Practice Address - Phone:916-771-8701
Practice Address - Fax:916-771-8710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory