Healthcare Provider Details

I. General information

NPI: 1780836601
Provider Name (Legal Business Name): INTEGRATED HEALTH AND WELLNESS CENTER, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2008
Last Update Date: 07/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 E 1ST ST
MCPHERSON KS
67460-3601
US

IV. Provider business mailing address

1319 E 1ST ST
MCPHERSON KS
67460-3601
US

V. Phone/Fax

Practice location:
  • Phone: 620-504-6344
  • Fax: 866-544-7606
Mailing address:
  • Phone: 620-504-6344
  • Fax: 866-544-7606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number01-04626
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateKS

VIII. Authorized Official

Name: DR. BRANDON GALE TROST
Title or Position: OWNER/DOCTOR
Credential: D.C.
Phone: 620-504-6344