Provider Demographics
NPI:1881967685
Name:INTEGRATED HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:INTEGRATED HEALTH SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:CHIKAO
Authorized Official - Last Name:MATSUMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:808-621-9842
Mailing Address - Street 1:711 KILANI AVE
Mailing Address - Street 2:
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-2071
Mailing Address - Country:US
Mailing Address - Phone:808-621-9842
Mailing Address - Fax:808-621-0006
Practice Address - Street 1:703 LANAI AVE.
Practice Address - Street 2:
Practice Address - City:LANAI CITY
Practice Address - State:HI
Practice Address - Zip Code:96763
Practice Address - Country:US
Practice Address - Phone:808-621-9842
Practice Address - Fax:808-621-0006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC456111N00000X
HIDC173111N00000X
HIDC140111N00000X
HIDC386111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty