Provider Demographics
NPI:1134460629
Name:ANDERSON INTEGRATIVE HEALTH CENTER INC
Entity Type:Organization
Organization Name:ANDERSON INTEGRATIVE HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:765-649-1991
Mailing Address - Street 1:1541 S SCATTERFIELD RD
Mailing Address - Street 2:STE A
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016-5784
Mailing Address - Country:US
Mailing Address - Phone:765-649-1991
Mailing Address - Fax:765-649-3383
Practice Address - Street 1:1541 S SCATTERFIELD RD
Practice Address - Street 2:STE A
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-5784
Practice Address - Country:US
Practice Address - Phone:765-649-1991
Practice Address - Fax:765-649-3383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN111N00000X, 208D00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty