Provider Demographics
NPI:1265299077
Name:KC INTEGRATIVE WELLNESS. LLC
Entity type:Organization
Organization Name:KC INTEGRATIVE WELLNESS. LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KATE
Authorized Official - Middle Name:R
Authorized Official - Last Name:LOPS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-699-0736
Mailing Address - Street 1:328 KELLY PLANTATION DR
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-3475
Mailing Address - Country:US
Mailing Address - Phone:850-699-0736
Mailing Address - Fax:
Practice Address - Street 1:327 MEDCREST DR UNIT A
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-6464
Practice Address - Country:US
Practice Address - Phone:850-699-0736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-28
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty