Organization
GRUNDY COUNTY PAIN CENTER SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE CARLSON (MGR)
(815) 942-6511
Entity
Organization
Contact information
Practice address
425 E US ROUTE 6, SUITE A, MORRIS, IL 60450-9042
(815) 942-6511
(815) 942-6582
Mailing address
425 E US ROUTE 6, SUITE A, MORRIS, IL 60450-9042
(815) 942-6511
(815) 942-6582
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
042617968
IL
261QP2000X
Physical Therapy Clinic/Center
042617968
IL
Other
Enumeration date
03/26/2007
Last updated
06/26/2008
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