| Organization Name: | INTERVENTIONAL PAIN MANAGEMENT, LTD. |
| NPI Number: | 1033155080 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PAUL C POLLACHEK (ADMINISTRATOR) |
| Mailing Address: | 10220 Wicker Ave Suite 3 Saint John |
| State: | IN US |
| Postal Code: | 463739424 |
| Phone Number: | 2195156943 |
| Fax Number: | |
| NPI Enumeration Date: | 06/20/2006 |
| NPI Last Update Date: | 01/19/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | 08/28/2013 |
| NPI Reactivation Date: | 10/14/2015 |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 60548471 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |