Provider Demographics
NPI:1114192812
Name:INTEGRATIVE MEDICINE CENTRE LLC
Entity Type:Organization
Organization Name:INTEGRATIVE MEDICINE CENTRE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:STUMP
Authorized Official - Suffix:
Authorized Official - Credentials:DC, EDD, LAC
Authorized Official - Phone:251-990-8188
Mailing Address - Street 1:PO BOX 1390
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36533-1390
Mailing Address - Country:US
Mailing Address - Phone:251-990-8188
Mailing Address - Fax:251-990-8159
Practice Address - Street 1:315 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-2413
Practice Address - Country:US
Practice Address - Phone:251-990-8188
Practice Address - Fax:251-990-8159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1206111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty