Provider Demographics
NPI:1164176699
Name:INTEGRATIVE CHIROPRACTIC OF MATTHEWS
Entity Type:Organization
Organization Name:INTEGRATIVE CHIROPRACTIC OF MATTHEWS
Other - Org Name:INTEGRATIVE CHIROPRACTIC AND NATURAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:R
Authorized Official - Last Name:DEGARAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-225-8686
Mailing Address - Street 1:12043 GUION LN
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-5033
Mailing Address - Country:US
Mailing Address - Phone:704-684-0093
Mailing Address - Fax:704-225-9988
Practice Address - Street 1:12043 GUION LN
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5033
Practice Address - Country:US
Practice Address - Phone:704-684-0093
Practice Address - Fax:704-225-9988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-03
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty