# IBARRA INTERVENTIONAL PAIN MANAGEMENT SC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023062460
- **Authorized official:** JUAN M. IBARRA M.D. (PRESIDENT/OWNER)
- **Authorized official phone:** (815) 235-2353

## Contact information

- **Practice address:** 1045 W STEPHENSON ST, FREEPORT, IL 61032-4864
- **Practice address phone:** (815) 599-6159
- **Mailing address:** PO BOX 123, FREEPORT, IL 61032-0123
- **Mailing address phone:** (815) 235-2353
- **Mailing address fax:** (815) 235-2353

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 173000000X | Legal Medicine | 036082621 | IL | Yes |

## Other

- **Enumeration date:** 05/20/2006
- **Last updated:** 03/29/2010