Provider Demographics
NPI:1891277042
Name:ADVANCED INTEGRATIVE MANUAL THERAPY
Entity Type:Organization
Organization Name:ADVANCED INTEGRATIVE MANUAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NEUROMUSCULAR THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:TURK
Authorized Official - Suffix:
Authorized Official - Credentials:CMT
Authorized Official - Phone:949-877-6547
Mailing Address - Street 1:1532 NEWPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-3715
Mailing Address - Country:US
Mailing Address - Phone:949-877-6547
Mailing Address - Fax:
Practice Address - Street 1:1532 NEWPORT BLVD
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627
Practice Address - Country:US
Practice Address - Phone:949-877-6547
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA53841OtherBUSINESS LICENSE