Organization
MIDWEST PAIN & SPINE CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GAYLE MUCCIANTE (PRACTICE ADMINISTRATOR)
(309) 692-7246
Entity
Organization
Contact information
Practice address
5401 N KNOXVILLE AVE, SUITE 416, PEORIA, IL 61614-5098
(309) 692-7246
(309) 692-7226
Mailing address
5401 N KNOXVILLE AVE, SUITE 416, PEORIA, IL 61614-5098
(309) 692-7246
(309) 692-7226
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
10/07/2015
Last updated
10/23/2015
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