Healthcare Provider Details

I. General information

NPI: 1164908711
Provider Name (Legal Business Name): WASHINGTON INTEGRATIVE HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 PENNSYLVANIA AVE SE STE 490
WASHINGTON DC
20003-6416
US

IV. Provider business mailing address

641 PENNSYLVANIA AVE SE
WASHINGTON DC
20003-4303
US

V. Phone/Fax

Practice location:
  • Phone: 202-843-5420
  • Fax:
Mailing address:
  • Phone: 202-544-4478
  • Fax: 202-835-2040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH30028
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN1036098
License Number StateDC
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN1015652
License Number StateDC

VIII. Authorized Official

Name: MR. MARLON COHEN
Title or Position: OWNER
Credential:
Phone: 202-843-5420