Provider Demographics
NPI:1710042031
Name:INTEGRATED HEALTHCARE CENTER, LLC
Entity Type:Organization
Organization Name:INTEGRATED HEALTHCARE CENTER, LLC
Other - Org Name:MOUNTAIN TOP CHIROPRACTIC AND NUTRITION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:CHOJNACKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-879-7246
Mailing Address - Street 1:1627 MERIDEN RD # A
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:CT
Mailing Address - Zip Code:06716-3231
Mailing Address - Country:US
Mailing Address - Phone:203-879-7246
Mailing Address - Fax:203-879-9340
Practice Address - Street 1:1627 MERIDEN RD # A
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:CT
Practice Address - Zip Code:06716-3231
Practice Address - Country:US
Practice Address - Phone:203-879-7246
Practice Address - Fax:203-879-9340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001404111N00000X
CT001401111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1821104720OtherNPI #, DR. CHOJNACKI
CT1841300860OtherNPI #, DR. SWIERCZYNSKI
CT1821104720OtherNPI #, DR. CHOJNACKI
CTU85006Medicare UPIN
CTC02753Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER