Provider Demographics
NPI:1891053393
Name:INTEGRATED MEDICAL INSTITUTE, LLC
Entity Type:Organization
Organization Name:INTEGRATED MEDICAL INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:WIZNITZER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:912-341-6006
Mailing Address - Street 1:310 EISENHOWER DR
Mailing Address - Street 2:BUILDING 12, SUITE C
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2632
Mailing Address - Country:US
Mailing Address - Phone:912-341-6006
Mailing Address - Fax:
Practice Address - Street 1:310 EISENHOWER DR
Practice Address - Street 2:BUILDING 12 SUITE C
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2632
Practice Address - Country:US
Practice Address - Phone:912-341-6006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-03
Last Update Date:2012-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5026111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty