Provider Demographics
NPI:1619291325
Name:INTEGRATIVE SPINE LLC
Entity Type:Organization
Organization Name:INTEGRATIVE SPINE LLC
Other - Org Name:KONSTANTINE BUNDE DC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KONSTANTINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BUNDE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:907-232-6376
Mailing Address - Street 1:1701 N SEWARD MERIDIAN PKWY
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6682
Mailing Address - Country:US
Mailing Address - Phone:907-357-7463
Mailing Address - Fax:907-376-5270
Practice Address - Street 1:1701 N SEWARD MERIDIAN PKWY
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6682
Practice Address - Country:US
Practice Address - Phone:907-357-7463
Practice Address - Fax:907-376-5270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-24
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK503111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty