Provider Demographics
NPI:1982993523
Name:INTEGRATIVE HEALTH CENTER LLC
Entity Type:Organization
Organization Name:INTEGRATIVE HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WRAY ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-283-8400
Mailing Address - Street 1:317 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64105-1215
Mailing Address - Country:US
Mailing Address - Phone:816-283-8400
Mailing Address - Fax:816-283-8708
Practice Address - Street 1:317 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64105-1215
Practice Address - Country:US
Practice Address - Phone:816-283-8400
Practice Address - Fax:816-283-8708
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTEGRATIVE HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-05
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000148597111N00000X
MO2006023729225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty