Provider Demographics
NPI:1356472302
Name:INTEGRAL CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:INTEGRAL CHIROPRACTIC LLC
Other - Org Name:SOUTH SOUND PAIN RELIEF CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR - OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WELLS
Authorized Official - Last Name:NEELY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-943-2940
Mailing Address - Street 1:2625 B PARKMONT LN SW, STE A
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-1048
Mailing Address - Country:US
Mailing Address - Phone:360-943-2940
Mailing Address - Fax:360-943-5616
Practice Address - Street 1:2625 B PARKMONT LN SW, STE A
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-1048
Practice Address - Country:US
Practice Address - Phone:360-943-2940
Practice Address - Fax:360-943-5616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034084111N00000X
WAMA00006430225700000X
WAMA00008767225700000X
WAMA00015063225700000X
WAMA60065983225700000X
WAMA60066736225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2026060Medicaid
WAAB32427Medicare ID - Type Unspecified