Provider Demographics
NPI:1407954928
Name:INTEGRATED HEALTH CENTER OF HANOVER LLC
Entity Type:Organization
Organization Name:INTEGRATED HEALTH CENTER OF HANOVER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMEMBER (PARTNER)
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PASTERNACK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:540-635-1270
Mailing Address - Street 1:1010 EICHELBERGER ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-1374
Mailing Address - Country:US
Mailing Address - Phone:717-630-2695
Mailing Address - Fax:717-632-4257
Practice Address - Street 1:1010 EICHELBERGER ST
Practice Address - Street 2:SUITE 9
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-1374
Practice Address - Country:US
Practice Address - Phone:717-630-2695
Practice Address - Fax:717-632-4257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008690111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA096536Medicare PIN