Provider Demographics
NPI:1598820185
Name:INTEGRATIVE FAMILY MEDICINE
Entity Type:Organization
Organization Name:INTEGRATIVE FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WACHS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-562-8800
Mailing Address - Street 1:4955 S DURANGO DR
Mailing Address - Street 2:#106
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-1053
Mailing Address - Country:US
Mailing Address - Phone:702-562-8800
Mailing Address - Fax:702-562-0009
Practice Address - Street 1:4955 S DURANGO DR
Practice Address - Street 2:#106
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-1053
Practice Address - Country:US
Practice Address - Phone:702-562-8800
Practice Address - Fax:702-562-0009
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTEGRATIVE FAMILY MEDICINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-26
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X, 207Q00000X
NVB00709111N00000X
NV9444207Q00000X
NV585363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002088311Medicaid
NVG77293Medicare UPIN
V34837Medicare PIN