Organization
COMPREHENSIVE PAIN & REHABILITATION CENTER P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD KIM (EXECUTIVE DIRECTOR)
(773) 816-0141
Entity
Organization
Contact information
Practice address
7300 N CICERO AVE, LINCOLNWOOD, IL 60712-1641
(847) 763-8010
(847) 763-8012
Mailing address
7300 N CICERO AVE, LINCOLNWOOD, IL 60712-1641
(847) 763-8010
(847) 763-8012
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
038008098
IL
111N00000X
Chiropractor
038011280
IL
208100000X
Physical Medicine & Rehabilitation Physician
336.057488
IL
2081N0008X
Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
036.056212
IL
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
036.056212
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
366760
MEDICARE PTAN
—
Enumeration date
04/27/2010
Last updated
04/27/2010
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