Provider Demographics
NPI:1639260615
Name:INTEGRATIVE SPINE & BODY MEDICINE
Entity Type:Organization
Organization Name:INTEGRATIVE SPINE & BODY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-771-8161
Mailing Address - Street 1:19401 40TH AVE W
Mailing Address - Street 2:SUITE 140
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4612
Mailing Address - Country:US
Mailing Address - Phone:425-771-8161
Mailing Address - Fax:425-771-7929
Practice Address - Street 1:19401 40TH AVE W
Practice Address - Street 2:SUITE 140
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4612
Practice Address - Country:US
Practice Address - Phone:425-771-8161
Practice Address - Fax:425-771-7929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602555899208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8858785Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
G8858785Medicare PIN