Brentwood Painstop LLC

Primary specialty

Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X

License

2014010441 Issued in MO

Legal business name

BRENTWOOD PAINSTOP LLC

Practice address

8045 Big Bend Blvd Ste 107
Saint Louis, MO 63119-2714

Phone

(314) 961-7181

NPI assigned

Oct 4, 2017

Organization subpart

No

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

Authorized official

Name

Nicholas J Divan, DC

Title

Chiropractor

Phone

(314) 961-7181

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1507075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507075200000",
    "number": "1225548290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8045 BIG BEND BLVD STE 107",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631192714",
            "telephone_number": "314-961-7181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8045 BIG BEND BLVD STE 107",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631192714",
            "telephone_number": "314-961-7181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRENTWOOD PAINSTOP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-04",
        "last_updated": "2017-10-04",
        "status": "A",
        "authorized_official_last_name": "DIVAN",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "314-961-7181",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": "MO",
            "license": "2014010441",
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "MO",
            "license": "2014010441",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pain Medicine (Physical Medicine & Rehabilitation) Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Pain Medicine (Physical Medicine & Rehabilitation) Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2017; 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.