Provider Demographics
NPI:1023601085
Name:PROCARE PAIN AND SPINE, LLC
Entity type:Organization
Organization Name:PROCARE PAIN AND SPINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C, DC
Authorized Official - Phone:775-828-9665
Mailing Address - Street 1:550 W PLUMB LN STE B
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-3686
Mailing Address - Country:US
Mailing Address - Phone:775-636-6200
Mailing Address - Fax:775-249-0010
Practice Address - Street 1:1 E LIBERTY ST STE 600
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89501-2110
Practice Address - Country:US
Practice Address - Phone:775-636-6200
Practice Address - Fax:775-249-0010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-19
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty