Provider Demographics
NPI:1649696089
Name:CRESTWOOD INTEGRATIVE HEALTH & WELLNESS CENTER
Entity type:Organization
Organization Name:CRESTWOOD INTEGRATIVE HEALTH & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-243-3334
Mailing Address - Street 1:6003 PLEASANT COLONY CT
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-8678
Mailing Address - Country:US
Mailing Address - Phone:502-243-3334
Mailing Address - Fax:502-243-9786
Practice Address - Street 1:6003 PLEASANT COLONY CT
Practice Address - Street 2:SUITE 1
Practice Address - City:CRESTWOOD
Practice Address - State:KY
Practice Address - Zip Code:40014-8678
Practice Address - Country:US
Practice Address - Phone:502-243-3334
Practice Address - Fax:502-243-9786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty