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Organization

MEDICOS PAIN & SURGICAL SPECIALISTS, S.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. DERRICK D. WALLERY D.C. (MANAGER)
(773) 283-3131
Entity
Organization

Contact information

Practice address
712 N DEARBORN ST, CHICAGO, IL 60654-3818
(773) 283-3131
(773) 283-3610
Mailing address
4176 W MONTROSE AVE, CHICAGO, IL 60641-2161
(773) 283-3131
(773) 283-3610

Taxonomy

Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary

Other

Enumeration date
08/20/2008
Last updated
08/20/2008
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