Provider Demographics
NPI:1326207259
Name:INTEGRATIVE CHIROPRACTIC & WELLNESS, LLC
Entity Type:Organization
Organization Name:INTEGRATIVE CHIROPRACTIC & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MICHAELS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-771-3471
Mailing Address - Street 1:106 CALENDAR CT
Mailing Address - Street 2:SUITE 94
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-2325
Mailing Address - Country:US
Mailing Address - Phone:708-771-3471
Mailing Address - Fax:
Practice Address - Street 1:7756 MADISON ST
Practice Address - Street 2:SUITE 8
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-2058
Practice Address - Country:US
Practice Address - Phone:708-711-3471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008307111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty