Provider Demographics
NPI:1750618245
Name:INTEGRATIVE CHIROPRACTIC FUSION
Entity type:Organization
Organization Name:INTEGRATIVE CHIROPRACTIC FUSION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:CHRISTINA
Authorized Official - Last Name:FURLONG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-386-4004
Mailing Address - Street 1:9225 ULMERTON RD
Mailing Address - Street 2:#306
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-3751
Mailing Address - Country:US
Mailing Address - Phone:727-386-4004
Mailing Address - Fax:727-386-4090
Practice Address - Street 1:9564 118TH LN
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-2705
Practice Address - Country:US
Practice Address - Phone:727-504-6931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 9841111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty