Provider Demographics
NPI:1689869620
Name:INTERACTIVE HEALTH ASSOCIATES INC
Entity Type:Organization
Organization Name:INTERACTIVE HEALTH ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:BAJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-920-0186
Mailing Address - Street 1:644 GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:KENILWORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60043-1003
Mailing Address - Country:US
Mailing Address - Phone:847-920-0186
Mailing Address - Fax:847-920-0189
Practice Address - Street 1:644 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:KENILWORTH
Practice Address - State:IL
Practice Address - Zip Code:60043-1003
Practice Address - Country:US
Practice Address - Phone:847-920-0186
Practice Address - Fax:847-920-0189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty