Basic Information
| Provider Information | |||||||||
| NPI: | 1467536896 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | INTEGRATIVE CHIROPRACTIC CLINIC LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2676 E AURORA RD | ||||||||
| Address2: | |||||||||
| City: | TWINSBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440872150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304252477 | ||||||||
| FaxNumber: | 3304252417 | ||||||||
| Practice Location | |||||||||
| Address1: | 2676 E AURORA RD | ||||||||
| Address2: | |||||||||
| City: | TWINSBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440872150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304252477 | ||||||||
| FaxNumber: | 3304252417 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 03/12/2013 | ||||||||
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| AuthorizedOfficialLastName: | HUANG | ||||||||
| AuthorizedOfficialFirstName: | MING JE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3304252477 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.C. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 3017 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.