Healthcare Provider Details

I. General information

NPI: 1982993523
Provider Name (Legal Business Name): INTEGRATIVE HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 04/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 DELAWARE ST
KANSAS CITY MO
64105-1215
US

IV. Provider business mailing address

317 DELAWARE ST
KANSAS CITY MO
64105-1215
US

V. Phone/Fax

Practice location:
  • Phone: 816-283-8400
  • Fax: 816-283-8708
Mailing address:
  • Phone: 816-283-8400
  • Fax: 816-283-8708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2000148597
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2006023729
License Number StateMO

VIII. Authorized Official

Name: WRAY ROBERT B. WILLIAMS
Title or Position: OWNER
Credential: DC
Phone: 816-283-8400