Provider Demographics
NPI:1144565623
Name:INTEGRATED FAMILY WELLNESS, INC.
Entity Type:Organization
Organization Name:INTEGRATED FAMILY WELLNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:ANCONA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-306-4284
Mailing Address - Street 1:2525 EMBASSY DR
Mailing Address - Street 2:SUITE 7
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33026-4573
Mailing Address - Country:US
Mailing Address - Phone:954-431-6884
Mailing Address - Fax:954-436-6936
Practice Address - Street 1:2525 EMBASSY DR
Practice Address - Street 2:SUITE 7
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33026-4573
Practice Address - Country:US
Practice Address - Phone:954-431-6884
Practice Address - Fax:954-436-6936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-10
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10364208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty