Provider Demographics
NPI:1093925455
Name:INTEGRATIVE HEALING DYNAMICS
Entity Type:Organization
Organization Name:INTEGRATIVE HEALING DYNAMICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MINH
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:858-558-0057
Mailing Address - Street 1:6540 LUSK BLVD STE C216
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-5794
Mailing Address - Country:US
Mailing Address - Phone:858-558-0057
Mailing Address - Fax:
Practice Address - Street 1:6540 LUSK BLVD STE C216
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-5794
Practice Address - Country:US
Practice Address - Phone:858-558-0057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty