Provider Demographics
NPI:1790945608
Name:INTEGRATED WELLNESS GROUP LLC
Entity Type:Organization
Organization Name:INTEGRATED WELLNESS GROUP LLC
Other - Org Name:INTEGRATED SPINE & DISC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:CLAYTON
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:985-626-0999
Mailing Address - Street 1:3441 E CAUSEWAY APPROACH
Mailing Address - Street 2:SUITE D
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-3480
Mailing Address - Country:US
Mailing Address - Phone:986-626-0999
Mailing Address - Fax:
Practice Address - Street 1:3441 E CAUSEWAY APPROACH
Practice Address - Street 2:SUITE D
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-3480
Practice Address - Country:US
Practice Address - Phone:986-626-0999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-13
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1231111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty