Provider Demographics
NPI:1457088122
Name:CHESAPEAKE INTEGRATIVE HEALTH SOLUTIONS LLC
Entity Type:Organization
Organization Name:CHESAPEAKE INTEGRATIVE HEALTH SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RDH, OMT
Authorized Official - Prefix:
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:KAINE
Authorized Official - Last Name:BOTTALICO
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:443-532-8331
Mailing Address - Street 1:134 CALVERT TOWNE RD
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-4100
Mailing Address - Country:US
Mailing Address - Phone:443-532-8331
Mailing Address - Fax:
Practice Address - Street 1:65 DUKE ST STE 107
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-6128
Practice Address - Country:US
Practice Address - Phone:443-532-8331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty