Provider Demographics
NPI:1033530720
Name:INTEGRATIVE CHIROPRACTIC & WELLNESS, LLC
Entity Type:Organization
Organization Name:INTEGRATIVE CHIROPRACTIC & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHRIOPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:ZEGEL
Authorized Official - Suffix:SR
Authorized Official - Credentials:DC
Authorized Official - Phone:978-688-5877
Mailing Address - Street 1:200 SUTTON ST
Mailing Address - Street 2:SUITE 142
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-1656
Mailing Address - Country:US
Mailing Address - Phone:978-688-5877
Mailing Address - Fax:978-688-4877
Practice Address - Street 1:200 SUTTON ST
Practice Address - Street 2:SUITE 142
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-1656
Practice Address - Country:US
Practice Address - Phone:978-688-5877
Practice Address - Fax:978-688-4877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACH1403111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty