Provider Demographics
NPI:1821486127
Name:INTEGRATED NUTRITION AND CHIROPRACTIC CENTER LTD
Entity Type:Organization
Organization Name:INTEGRATED NUTRITION AND CHIROPRACTIC CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUDY
Authorized Official - Middle Name:H
Authorized Official - Last Name:SO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-793-6077
Mailing Address - Street 1:6518 N CLARK ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-4002
Mailing Address - Country:US
Mailing Address - Phone:773-793-6077
Mailing Address - Fax:
Practice Address - Street 1:6518 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-4002
Practice Address - Country:US
Practice Address - Phone:773-793-6077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011175111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty