| Organization Name: | GRUNDY COUNTY PAIN CENTER SC |
| NPI Number: | 1083731608 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DIANE CARLSON (MGR) |
| Mailing Address: | 425 E Us Route 6 Suite A Morris |
| State: | IL US |
| Postal Code: | 604509042 |
| Phone Number: | 8159426511 |
| Fax Number: | 8159426582 |
| NPI Enumeration Date: | 03/26/2007 |
| NPI Last Update Date: | 06/26/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | 042617968 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |