Provider Demographics
NPI:1881639532
Name:INTEGRATED HEALTH & WELLNESS CARE CENTER
Entity Type:Organization
Organization Name:INTEGRATED HEALTH & WELLNESS CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:KOBSAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:408-294-2322
Mailing Address - Street 1:42 RACE ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-3130
Mailing Address - Country:US
Mailing Address - Phone:408-294-2322
Mailing Address - Fax:408-294-2232
Practice Address - Street 1:42 RACE ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-3130
Practice Address - Country:US
Practice Address - Phone:408-294-2322
Practice Address - Fax:408-294-2232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23869111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0238690Medicare ID - Type Unspecified