Provider Demographics
NPI:1629396452
Name:INTEGRATED NUTRITION AND CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:INTEGRATED NUTRITION AND CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:GECK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:734-661-8100
Mailing Address - Street 1:210 LITTLE LAKE DR
Mailing Address - Street 2:SUITE 8
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-6218
Mailing Address - Country:US
Mailing Address - Phone:734-661-8100
Mailing Address - Fax:734-661-8101
Practice Address - Street 1:210 LITTLE LAKE DR
Practice Address - Street 2:SUITE 8
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-6218
Practice Address - Country:US
Practice Address - Phone:734-661-8100
Practice Address - Fax:734-661-8101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-04
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009102111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIV08857Medicare UPIN