14D2151755 CLIA NUMBER - INTEGRATIVE MEDICAL PAIN CLINIC

Laboratory Demographics

CLIA Number: 14D2151755

Facility Name: INTEGRATIVE MEDICAL PAIN CLINIC

Facility Address:
4793 MANHATTAN DR
ROCKFORD, IL
ZIP 61107
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Facility Phone Number: 815 398-7246

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1164845459

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	14D2151755
LAB Type	Physician Office
Facility Name	INTEGRATIVE MEDICAL PAIN CLINIC
Street	4793 MANHATTAN DR
City	ROCKFORD
State	IL
ZIP	61107
Phone	815 398-7246
CertificateType	4
CertificateEffectiveDate	7/26/2022
CertificateExpirationDate	7/25/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024