Organization
DAYTON PAIN CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT GRANT GOODWIN DC (PRACTICE MANAGER)
(937) 952-6567
Entity
Organization
Contact information
Practice address
1 ELIZABETH PL STE D, DAYTON, OH 45417-3445
(937) 222-2233
(937) 222-9665
Mailing address
1 ELIZABETH PL STE D, DAYTON, OH 45417-3445
(937) 222-2233
(937) 222-9665
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36D1096643
CLIA
OH
Enumeration date
01/31/2018
Last updated
06/16/2018
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