Provider Demographics
NPI:1235370446
Name:INTEGRATIVE CHIROPRACTIC & PHYSICAL THERAPY SOLUTIONS
Entity Type:Organization
Organization Name:INTEGRATIVE CHIROPRACTIC & PHYSICAL THERAPY SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT./OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:A
Authorized Official - Last Name:CANN
Authorized Official - Suffix:
Authorized Official - Credentials:CHIROPRACTOR, DC
Authorized Official - Phone:850-916-9304
Mailing Address - Street 1:4657 GULF BREEZE PKWY
Mailing Address - Street 2:UNITS A & B
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-9166
Mailing Address - Country:US
Mailing Address - Phone:850-916-9304
Mailing Address - Fax:850-916-9306
Practice Address - Street 1:4657 GULF BREEZE PKWY
Practice Address - Street 2:UNITS A & B
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-9166
Practice Address - Country:US
Practice Address - Phone:850-916-9304
Practice Address - Fax:850-916-9306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8649111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU6935ZMedicare PIN