The Pain Clinic Inc.

Primary specialty

Neuromusculoskeletal Medicine & OMM PhysicianTaxonomy code 204D00000X

License

036-063384 Issued in IL

Legal business name

THE PAIN CLINIC INC.

Practice address

3674 Ridge Rd
Lansing, IL 60438-3144

Phone

(708) 474-2700

Fax

(708) 474-3300

NPI assigned

Apr 22, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Charles A. Gross, D.C.

Title

President

Phone

(708) 474-2700

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1240358400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437523200000",
    "number": "1407090350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3674 RIDGE RD",
            "city": "LANSING",
            "state": "IL",
            "postal_code": "604383144",
            "telephone_number": "708-474-2700",
            "fax_number": "708-474-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3674 RIDGE RD",
            "city": "LANSING",
            "state": "IL",
            "postal_code": "604383144",
            "telephone_number": "708-474-2700",
            "fax_number": "708-474-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PAIN CLINIC INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-22",
        "last_updated": "2015-07-22",
        "status": "A",
        "authorized_official_last_name": "GROSS",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-474-2700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038-006292",
            "primary": false
        },
        {
            "code": "204D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "IL",
            "license": "036-063384",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Neuromusculoskeletal Medicine & OMM Physician in Lansing, IL
• Providers in Lansing, IL by specialty
• Neuromusculoskeletal Medicine & OMM Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 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.