Organization
HAVEN SPINE & PAIN CENTER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACK DILLON (EXECUTIVE DIRECTOR)
(312) 505-1033
Entity
Organization
Contact information
Practice address
2680 LEONARD ST NE STE 3, GRAND RAPIDS, MI 49525-6902
(616) 364-4200
(616) 364-7347
Mailing address
2680 LEONARD ST NE STE 3, GRAND RAPIDS, MI 49525-6902
(616) 364-4200
(616) 364-7347
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
208VP0000X
Pain Medicine Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
Other
Enumeration date
01/21/2021
Last updated
12/09/2021
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