Provider Demographics
NPI:1508171760
Name:INTEGRATED HEALTH SYSTEMS
Entity Type:Organization
Organization Name:INTEGRATED HEALTH SYSTEMS
Other - Org Name:MOUNTAIN HEALTH CHIROPRACTIC AND NEUROLOGY CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:STEADMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC , DACNB, CNS
Authorized Official - Phone:303-781-5617
Mailing Address - Street 1:3601 S CLARKSON ST STE 420
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-3948
Mailing Address - Country:US
Mailing Address - Phone:303-781-5617
Mailing Address - Fax:303-781-1045
Practice Address - Street 1:3601 S CLARKSON ST STE 420
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3948
Practice Address - Country:US
Practice Address - Phone:303-781-5617
Practice Address - Fax:303-781-1045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-12
Last Update Date:2020-03-31
Deactivation Date:2018-03-19
Deactivation Code:
Reactivation Date:2020-03-31
Provider Licenses
StateLicense IDTaxonomies
CO5404111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO499578OtherBC/BS
CO499578OtherBC/BS