Provider Demographics
NPI:1932294964
Name:INTEGRATED NEUROLOGY PC
Entity Type:Organization
Organization Name:INTEGRATED NEUROLOGY PC
Other - Org Name:ASHCROFT CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:WOODBURY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:802-775-4372
Mailing Address - Street 1:279 BUSINESS ROUTE 4
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CENTER RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05736-9731
Mailing Address - Country:US
Mailing Address - Phone:802-775-4372
Mailing Address - Fax:802-775-4918
Practice Address - Street 1:279 BUSINESS ROUTE 4
Practice Address - Street 2:SUITE 1
Practice Address - City:CENTER RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05736-9731
Practice Address - Country:US
Practice Address - Phone:802-775-4372
Practice Address - Fax:802-775-4918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTINTE00059811OtherBCBS
VTINTE00059811OtherBCBS