Provider Demographics
NPI:1437758299
Name:INTEGRATED CHIROPRACTIC WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:INTEGRATED CHIROPRACTIC WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-826-3808
Mailing Address - Street 1:1449 W YAMATO RD STE 2
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-4471
Mailing Address - Country:US
Mailing Address - Phone:561-826-3808
Mailing Address - Fax:561-826-3806
Practice Address - Street 1:1449 W YAMATO RD STE 2
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-4471
Practice Address - Country:US
Practice Address - Phone:561-826-3808
Practice Address - Fax:561-826-3806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty