| NPI | 1922396928 |
|---|---|
| Former Legal Business Name | SHEPARD PAIN AND PERFORMANCE CARE PC |
| Entity Type | Organization |
| Authorized Contact | MATTHEW J SHEPARD President 815-980-5706 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111NR0400X (Licence: IL 038011982) |
| Enumeration Date | 2011-07-12 |
| Last Update Date | 2011-07-12 |