Healthcare Provider Details

I. General information

NPI: 1275836017
Provider Name (Legal Business Name): INTEGRATIVE WELLNESS GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2010
Last Update Date: 12/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 3RD ST
CASTLE ROCK CO
80104-2438
US

IV. Provider business mailing address

340 3RD ST
CASTLE ROCK CO
80104-2438
US

V. Phone/Fax

Practice location:
  • Phone: 303-814-9262
  • Fax: 303-814-9264
Mailing address:
  • Phone: 303-814-9262
  • Fax: 303-814-9264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6334
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4045
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberACU1610
License Number StateCO

VIII. Authorized Official

Name: DR. DAVID BARTON
Title or Position: OWNER
Credential: DC
Phone: 303-814-9262