Healthcare Provider Details

I. General information

NPI: 1306237300
Provider Name (Legal Business Name): INTEGRATIVE PHYSICIAN SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2015
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4490 N US HIGHWAY 1 SUITE 108
BUNNELL FL
32110-4374
US

IV. Provider business mailing address

138 PALM COAST PKWY NE SUITE 127
PALM COAST FL
32137-8241
US

V. Phone/Fax

Practice location:
  • Phone: 800-362-4183
  • Fax: 386-456-3071
Mailing address:
  • Phone: 800-362-4183
  • Fax: 386-456-3071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberCH11373
License Number StateFL

VIII. Authorized Official

Name: DR. STEVEN WILLIAM OLIVER
Title or Position: OWNER/PHYSICIAN
Credential: D.C.
Phone: 800-362-4183