Provider Demographics
NPI:1528326352
Name:NORTH STATE PAIN MANAGEMENT
Entity type:Organization
Organization Name:NORTH STATE PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:530-566-1234
Mailing Address - Street 1:2062 TALBERT DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-7719
Mailing Address - Country:US
Mailing Address - Phone:530-566-1234
Mailing Address - Fax:530-566-1124
Practice Address - Street 1:2062 TALBERT DR
Practice Address - Street 2:SUITE 300
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-7719
Practice Address - Country:US
Practice Address - Phone:530-566-1234
Practice Address - Fax:530-566-1124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-30
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207LP2900X, 208VP0014X, 208VP0000X
CADC0227220111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty