Provider Demographics
NPI:1467536896
Name:INTEGRATIVE CHIROPRACTIC CLINIC LLC
Entity Type:Organization
Organization Name:INTEGRATIVE CHIROPRACTIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MING JE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUANG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-425-2477
Mailing Address - Street 1:2676 E AURORA RD
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-2150
Mailing Address - Country:US
Mailing Address - Phone:330-425-2477
Mailing Address - Fax:330-425-2417
Practice Address - Street 1:2676 E AURORA RD
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-2150
Practice Address - Country:US
Practice Address - Phone:330-425-2477
Practice Address - Fax:330-425-2417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3017111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHHU4057173Medicare PIN
OHIN9353921Medicare PIN
OHU86256Medicare UPIN