Provider Demographics
NPI:1407192107
Name:TOTAL INTEGRATED WELLNESS, INC
Entity Type:Organization
Organization Name:TOTAL INTEGRATED WELLNESS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESEDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:JENISON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:775-825-3625
Mailing Address - Street 1:4600 KIETZKE LN
Mailing Address - Street 2:M 249
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-5033
Mailing Address - Country:US
Mailing Address - Phone:775-825-3625
Mailing Address - Fax:
Practice Address - Street 1:4600 KIETZKE LN
Practice Address - Street 2:M 249
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-5033
Practice Address - Country:US
Practice Address - Phone:775-825-3625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-27
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01357261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center