Provider Demographics
NPI:1114227691
Name:INTEGRA CHIROPRACTIC GROUP
Entity Type:Organization
Organization Name:INTEGRA CHIROPRACTIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HETUL
Authorized Official - Middle Name:
Authorized Official - Last Name:BHAKTA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:361-985-2225
Mailing Address - Street 1:5866 S STAPLES ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-3700
Mailing Address - Country:US
Mailing Address - Phone:361-985-2225
Mailing Address - Fax:361-985-2285
Practice Address - Street 1:5866 S STAPLES ST
Practice Address - Street 2:SUITE 101
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-3700
Practice Address - Country:US
Practice Address - Phone:361-985-2225
Practice Address - Fax:361-985-2285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-29
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10152111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty