Provider Demographics
NPI:1598276313
Name:INTEGRATIVE HEALTH CLINIC
Entity Type:Organization
Organization Name:INTEGRATIVE HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RODRIGO
Authorized Official - Middle Name:EDUARDO
Authorized Official - Last Name:PINA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-792-5490
Mailing Address - Street 1:24846 NARBONNE AVE
Mailing Address - Street 2:
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717
Mailing Address - Country:US
Mailing Address - Phone:310-792-5490
Mailing Address - Fax:424-316-2562
Practice Address - Street 1:24846 NARBONNE AVE
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717
Practice Address - Country:US
Practice Address - Phone:310-792-5490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29192111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty