Provider Demographics
NPI:1427004779
Name:INTEGRATED HEALTH
Entity Type:Organization
Organization Name:INTEGRATED HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LEONID
Authorized Official - Last Name:STYCHNO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-399-4000
Mailing Address - Street 1:953 NILES CORTLAND RD SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-2538
Mailing Address - Country:US
Mailing Address - Phone:330-399-4000
Mailing Address - Fax:330-399-4015
Practice Address - Street 1:953 NILES CORTLAND RD.
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484
Practice Address - Country:US
Practice Address - Phone:330-399-4000
Practice Address - Fax:330-399-4015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2681405Medicaid
=========00OtherBWC
IN9362451Medicare PIN