Provider Demographics
NPI:1326301649
Name:WHOLE HEALTH INTEGRATED MEDICINE
Entity Type:Organization
Organization Name:WHOLE HEALTH INTEGRATED MEDICINE
Other - Org Name:QUANTUM HEALTH SOLUTIONS GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:ALICE
Authorized Official - Last Name:MELLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:FNPC
Authorized Official - Phone:720-560-3083
Mailing Address - Street 1:9997 S YOSEMITE ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124
Mailing Address - Country:US
Mailing Address - Phone:720-560-3083
Mailing Address - Fax:877-613-8072
Practice Address - Street 1:9997 S YOSEMITE ST
Practice Address - Street 2:SUITE 110
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124
Practice Address - Country:US
Practice Address - Phone:720-560-3083
Practice Address - Fax:877-613-8072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-21
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO111N00000X, 363LP2300X
207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty