Provider Demographics
NPI:1457890600
Name:INTEGRATED HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:INTEGRATED HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-985-7070
Mailing Address - Street 1:2509 S POWER RD
Mailing Address - Street 2:115
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-6695
Mailing Address - Country:US
Mailing Address - Phone:480-985-7070
Mailing Address - Fax:480-641-7408
Practice Address - Street 1:2509 S POWER RD
Practice Address - Street 2:115
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-6695
Practice Address - Country:US
Practice Address - Phone:480-985-7070
Practice Address - Fax:480-641-7408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty