FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-746097
1. AMERICAN SOCIETY OF INTERVENTIONAL PAIN PHYSICIAN PAC
2831 Lone Oak RoadPaducah, KY 42003
Email: paula@thepainmd.com
NOTE: Email address is different than previously reported
2. Date: 09/22/2011
3. FEC Committee ID #: C00351197 This committee is a separate segregated fund. Its connected organization is a Membership OrganizationAffiliated Committees/Organizations
American Society of International Pain Physicians2831 Lone Oak Road
Paducha, Kentucky 42003
Affiliated Relationship Code: Connected Organization
Custodian of Records:
Treasurer:
Laxmaiah Manchikanti2075 Natchez Lane
Paducah, Kentucky 42001
Title: Treasurer
Phone # (270) 554-8373
Designated Agent(s):
Yogesh Malla6510 Tuscan Road
Paducah, Kentucky 42003
Title: Assistant Tresurer
Phone # (270) 554-8373
Banks or Depositories
Bantera Bank3151 Jackson Street
Paducah, Kentucky 42003