Provider Demographics
NPI:1023469939
Name:INTEGRATED WHIPLASH RECOVERY GROUP
Entity type:Organization
Organization Name:INTEGRATED WHIPLASH RECOVERY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MISUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:435-753-2253
Mailing Address - Street 1:1415 N 400 E
Mailing Address - Street 2:SUITE C
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-7539
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1415 N 400 E
Practice Address - Street 2:SUITE C
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-7539
Practice Address - Country:US
Practice Address - Phone:435-753-2253
Practice Address - Fax:435-787-9422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty