Provider Demographics
NPI:1841525680
Name:INNOVATIVE HEALING CENTER LLC
Entity type:Organization
Organization Name:INNOVATIVE HEALING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/L. AC.
Authorized Official - Prefix:
Authorized Official - First Name:TENA
Authorized Official - Middle Name:CARROLL
Authorized Official - Last Name:SCARBER
Authorized Official - Suffix:
Authorized Official - Credentials:L AC
Authorized Official - Phone:972-742-1152
Mailing Address - Street 1:5608 SOUTHERN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-6863
Mailing Address - Country:US
Mailing Address - Phone:972-742-1152
Mailing Address - Fax:972-867-6376
Practice Address - Street 1:4100 W 15TH ST
Practice Address - Street 2:220
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5803
Practice Address - Country:US
Practice Address - Phone:972-742-1152
Practice Address - Fax:972-867-6376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX06690111N00000X
TX00754171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty