FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-204148
1. AMERICAN SOCIETY OF INTERVENTIONAL PAIN PHYSICIAN PAC
2831 Lone Oak RoadPaducah, KY 42003
Email: drm@thepainmd.com
2. Date: 02/24/2006
3. FEC Committee ID #: C00351197 This committee is a Separate Segregated FundAffiliated Committees/Organizations
Society of Interventional Pain Management Surgery Centers PAC2831 Lone Oak Road
Paducah, Kentucky 42003
Relationship: Affiliated
Organization Type: Corporation
Custodian of Records:
Treasurer:
Laxmaiah Manchikanti2075 Natchez Lane
Paducah, Kentucky 42001
Title: President
Phone # (270) 554-8373
Designated Agent(s):
Dr. Jose J. Rivera450 Ash Creek
Paducah, Kentucky 42001
Banks or Depositories
Bantera Bank3151 Jackson Street
Paducah, Kentucky 42003