Provider Demographics
NPI:1356629828
Name:INTERGRATIVE MEDICINE&HOLISTIC WELLNESS CTR
Entity Type:Organization
Organization Name:INTERGRATIVE MEDICINE&HOLISTIC WELLNESS CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-790-0606
Mailing Address - Street 1:677 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3493
Mailing Address - Country:US
Mailing Address - Phone:508-790-0606
Mailing Address - Fax:508-790-0808
Practice Address - Street 1:677 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3493
Practice Address - Country:US
Practice Address - Phone:508-790-0606
Practice Address - Fax:508-790-0808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA439111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1606221Medicaid
MA1617265Medicaid
MA1617265Medicaid