Provider Demographics
NPI:1255485892
Name:INTEGRATED HEALTHCARE & SPORTS SPECIALISTS, LLC
Entity Type:Organization
Organization Name:INTEGRATED HEALTHCARE & SPORTS SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DR. DANIEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:TERRAY, JR.
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-239-4404
Mailing Address - Street 1:42 STATE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2245
Mailing Address - Country:US
Mailing Address - Phone:203-239-4404
Mailing Address - Fax:
Practice Address - Street 1:42 STATE ST
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-2245
Practice Address - Country:US
Practice Address - Phone:203-239-4404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001490111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty