Provider Demographics
NPI:1477676534
Name:THE WOODLANDS INTEGRATIVE MED. ASSOC.
Entity type:Organization
Organization Name:THE WOODLANDS INTEGRATIVE MED. ASSOC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUMPKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-419-0076
Mailing Address - Street 1:6769 LAKE WOODLANDS DR STE E
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-2771
Mailing Address - Country:US
Mailing Address - Phone:281-419-0076
Mailing Address - Fax:281-419-0136
Practice Address - Street 1:6769 LAKE WOODLANDS DR STE E
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382-2771
Practice Address - Country:US
Practice Address - Phone:281-419-0076
Practice Address - Fax:281-419-0136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC9081111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7454496OtherAETNA HEALTHCARE
TX608168OtherBLUE CROSS BLUE SHIELD