Provider Demographics
NPI:1811140056
Name:INTEGRATIVE HEALTH LLC
Entity type:Organization
Organization Name:INTEGRATIVE HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACKYE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:804-399-0002
Mailing Address - Street 1:7305 HANCOCK VILLAGE DR # 118
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-2771
Mailing Address - Country:US
Mailing Address - Phone:804-399-0002
Mailing Address - Fax:
Practice Address - Street 1:15521 MIDLOTHIAN TPKE STE 402
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-7313
Practice Address - Country:US
Practice Address - Phone:804-399-0002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-31
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty