Healthcare Provider Details

I. General information

NPI: 1235467762
Provider Name (Legal Business Name): INTEGRATED HEALTH MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2009
Last Update Date: 01/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1099 MILWAUKEE ST SUITE 30
SAINT LOUIS MO
63122-7356
US

IV. Provider business mailing address

1099 MILWAUKEE ST SUITE 30
KIRKWOOD MO
63122-7356
US

V. Phone/Fax

Practice location:
  • Phone: 314-725-2640
  • Fax: 314-966-0233
Mailing address:
  • Phone: 314-725-2640
  • Fax: 314-966-0233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCE006144
License Number StateMO

VIII. Authorized Official

Name: DR. STEPHEN J FELDMAN
Title or Position: CHIROPRACTOR, ACUPUNCTURIST
Credential: DC, FIAMA
Phone: 314-725-2640