Provider Demographics
NPI:1023209046
Name:FOUNDATIONS INTEGRATIVE HEALTH, LLC
Entity Type:Organization
Organization Name:FOUNDATIONS INTEGRATIVE HEALTH, LLC
Other - Org Name:FOUNDATIONS CHIROPRACTIC & WELLNESS CTR
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:BYERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:614-797-9355
Mailing Address - Street 1:615 COPELAND MILL RD
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8904
Mailing Address - Country:US
Mailing Address - Phone:614-797-9355
Mailing Address - Fax:614-882-1886
Practice Address - Street 1:615 COPELAND MILL RD
Practice Address - Street 2:SUITE 1C
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8904
Practice Address - Country:US
Practice Address - Phone:614-797-9355
Practice Address - Fax:614-882-1886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3114111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9339641Medicare PIN