Provider Demographics
NPI:1790848273
Name:INTEGRATIVE CHIROPRACTIC
Entity Type:Organization
Organization Name:INTEGRATIVE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:XIONG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-584-9290
Mailing Address - Street 1:160 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-4218
Mailing Address - Country:US
Mailing Address - Phone:860-584-9290
Mailing Address - Fax:860-583-9590
Practice Address - Street 1:160 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-4218
Practice Address - Country:US
Practice Address - Phone:860-584-9290
Practice Address - Fax:860-583-9590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1638111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty