Provider Demographics
NPI:1487720678
Name:PHYSICAL PAIN MANAGEMENT, P.C.
Entity type:Organization
Organization Name:PHYSICAL PAIN MANAGEMENT, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:MARC
Authorized Official - Last Name:MCDONOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-225-7246
Mailing Address - Street 1:1150 WASHINGTON RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-9683
Mailing Address - Country:US
Mailing Address - Phone:724-225-7246
Mailing Address - Fax:724-225-9124
Practice Address - Street 1:1150 WASHINGTON RD
Practice Address - Street 2:SUITE 104
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-9683
Practice Address - Country:US
Practice Address - Phone:724-225-7246
Practice Address - Fax:724-225-9124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007656L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA033864LZLMedicare ID - Type UnspecifiedCHIROPRACTOR