Provider Demographics
NPI:1295366888
Name:INTEGRATE CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:INTEGRATE CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:P
Authorized Official - Last Name:TWENGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-300-1461
Mailing Address - Street 1:20520 KEOKUK AVE # LL30
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-6083
Mailing Address - Country:US
Mailing Address - Phone:952-300-1461
Mailing Address - Fax:
Practice Address - Street 1:20520 KEOKUK AVE # LL30
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-6083
Practice Address - Country:US
Practice Address - Phone:952-300-1461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty