Healthcare Provider Details

I. General information

NPI: 1336536028
Provider Name (Legal Business Name): INTEGRATED WELLNESS AND PAIN MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2015
Last Update Date: 04/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2135 N RIDGE RD STE 200
WICHITA KS
67212-1404
US

IV. Provider business mailing address

2135 N RIDGE RD STE 200
WICHITA KS
67212-1404
US

V. Phone/Fax

Practice location:
  • Phone: 316-201-1122
  • Fax:
Mailing address:
  • Phone: 316-201-1122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GREGORY LAKIN
Title or Position: OWNER
Credential: DO
Phone: 316-201-1122