Provider Demographics
NPI:1083057434
Name:INTEGRATIVE BODY HEALTH, PC
Entity Type:Organization
Organization Name:INTEGRATIVE BODY HEALTH, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLYDE
Authorized Official - Middle Name:EMIR
Authorized Official - Last Name:NAVARRO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-485-3155
Mailing Address - Street 1:775 S PARK ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3825
Mailing Address - Country:US
Mailing Address - Phone:770-832-1640
Mailing Address - Fax:770-832-1649
Practice Address - Street 1:775 S PARK ST
Practice Address - Street 2:SUITE 102
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3825
Practice Address - Country:US
Practice Address - Phone:770-832-1640
Practice Address - Fax:770-832-1649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-15
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008718111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty