Provider Demographics
NPI:1649200957
Name:THE PAIN CENTER
Entity type:Organization
Organization Name:THE PAIN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:GURAGOSSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-975-5950
Mailing Address - Street 1:4416 N. LINCOLN AVE.
Mailing Address - Street 2:STE. 2000
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640
Mailing Address - Country:US
Mailing Address - Phone:773-975-5950
Mailing Address - Fax:
Practice Address - Street 1:4116 N LINCOLN AVE
Practice Address - Street 2:SUITE 2000
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3028
Practice Address - Country:US
Practice Address - Phone:773-975-1818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty