Pain and Brain Healing Center, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

1836 Issued in MN

Legal business name

PAIN AND BRAIN HEALING CENTER, LLC

Practice address

1400 131St Ave NE
Blaine, MN 55449-4124

Phone

(763) 862-7100

NPI assigned

Apr 17, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Gregory Charles Fors, DC

Title

Clinic Director

Phone

(763) 862-7100

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1239926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430438400000",
    "number": "1184867319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 131ST AVE NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554494124",
            "telephone_number": "763-862-7100",
            "fax_number": "763-862-7077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 131ST AVE NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554494124",
            "telephone_number": "763-862-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAIN AND BRAIN HEALING CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-17",
        "last_updated": "2015-05-01",
        "status": "A",
        "authorized_official_last_name": "FORS",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "763-862-7100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MN",
            "license": "1836",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Blaine, MN
• Providers in Blaine, MN by specialty
• Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2015; 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.