Healthcare Provider Details

I. General information

NPI: 1922202001
Provider Name (Legal Business Name): INTEGRATED HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 09/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3405 DALLAS HWY SW STE 301
MARIETTA GA
30064-6426
US

IV. Provider business mailing address

3405 DALLAS HWY SW STE 301
MARIETTA GA
30064-6426
US

V. Phone/Fax

Practice location:
  • Phone: 678-699-3238
  • Fax:
Mailing address:
  • Phone: 678-699-3238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCHIR007533
License Number StateGA

VIII. Authorized Official

Name: DR. CHRISTOPHER CAMPAGNA
Title or Position: OWNER
Credential: DC
Phone: 678-699-3238