Provider Demographics
NPI:1578926812
Name:TOTAL HEALTH INDUSTRIES NC, LLC
Entity Type:Organization
Organization Name:TOTAL HEALTH INDUSTRIES NC, LLC
Other - Org Name:INTEGRA WELLNESS & CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DABCO
Authorized Official - Phone:704-626-2550
Mailing Address - Street 1:1040 EDGEWATER CORPORATE PKWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:INDIAN LAND
Mailing Address - State:SC
Mailing Address - Zip Code:29707-4514
Mailing Address - Country:US
Mailing Address - Phone:704-626-2550
Mailing Address - Fax:704-626-2550
Practice Address - Street 1:1040 EDGEWATER CORPORATE PKWY
Practice Address - Street 2:SUITE 104
Practice Address - City:INDIAN LAND
Practice Address - State:SC
Practice Address - Zip Code:29707-4514
Practice Address - Country:US
Practice Address - Phone:704-626-2550
Practice Address - Fax:704-626-2550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4018111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty