Provider Demographics
NPI:1891988606
Name:INTEGRATIVE WELLNESS ASSOCIATES, PC
Entity Type:Organization
Organization Name:INTEGRATIVE WELLNESS ASSOCIATES, PC
Other - Org Name:AGELESS LIVING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:AKERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-969-0884
Mailing Address - Street 1:10576 W ALAMEDA AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-2600
Mailing Address - Country:US
Mailing Address - Phone:303-969-0884
Mailing Address - Fax:303-969-0019
Practice Address - Street 1:10576 W ALAMEDA AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-2600
Practice Address - Country:US
Practice Address - Phone:303-969-0884
Practice Address - Fax:303-969-0019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3988111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO803654Medicare PIN
COV07061Medicare UPIN