NPIMap

Organization Active NPI

Grundy County Pain Center SC

  • Chiropractor
  • Morris, IL
National Provider Identifier
1083731608
Registry record updated Jun 26, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
042617968 Issued in IL
Legal business name
GRUNDY COUNTY PAIN CENTER SC
Practice address
425 E US Route 6
Suite a
Morris, IL 60450-9042
Phone
(815) 942-6511
Fax
(815) 942-6582
NPI assigned
Mar 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Diane Carlson
Title
MGR
Phone
(815) 942-6511

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X 042617968 IL Primary
Physical Therapy Clinic/Center 261QP2000X 042617968 IL

Addresses

Primary practice location

425 E US Route 6
Suite a
Morris, IL 60450-9042

Mailing address

425 E US Route 6
Suite a
Morris, IL 60450-9042
Phone (815) 942-6511

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214438400000",
    "number": "1083731608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 E US ROUTE 6",
            "address_2": "SUITE A",
            "city": "MORRIS",
            "state": "IL",
            "postal_code": "604509042",
            "telephone_number": "815-942-6511",
            "fax_number": "815-942-6582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 E US ROUTE 6",
            "address_2": "SUITE A",
            "city": "MORRIS",
            "state": "IL",
            "postal_code": "604509042",
            "telephone_number": "815-942-6511",
            "fax_number": "815-942-6582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRUNDY COUNTY PAIN CENTER SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-26",
        "last_updated": "2008-06-26",
        "status": "A",
        "authorized_official_last_name": "CARLSON",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "MGR",
        "authorized_official_telephone_number": "815-942-6511"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "042617968",
            "primary": true
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "IL",
            "license": "042617968",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Morris, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.