Provider Demographics
NPI:1013157288
Name:INTEGRATED HEALTHCARE SERVICES GOLDEN VALLEY PA
Entity Type:Organization
Organization Name:INTEGRATED HEALTHCARE SERVICES GOLDEN VALLEY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MASSOGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-593-0919
Mailing Address - Street 1:6480 WAYZATA BLVD
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1710
Mailing Address - Country:US
Mailing Address - Phone:763-593-0919
Mailing Address - Fax:763-593-9556
Practice Address - Street 1:700 TWELVE OAKS CENTER DR
Practice Address - Street 2:SUITE 101
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-4401
Practice Address - Country:US
Practice Address - Phone:952-893-8900
Practice Address - Fax:952-893-7399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-02
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN618111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN=========OtherFEDERAL TAX ID