Provider Demographics
NPI:1194202630
Name:INTEGRATE HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:INTEGRATE HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:WITHERSPOON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-378-9927
Mailing Address - Street 1:133 KEYBRIDGE DR STE B
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-5915
Mailing Address - Country:US
Mailing Address - Phone:919-378-9927
Mailing Address - Fax:919-650-1861
Practice Address - Street 1:133 KEYBRIDGE DR STE B
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-5915
Practice Address - Country:US
Practice Address - Phone:919-378-9927
Practice Address - Fax:919-650-1861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4729111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty