Healthcare Provider Details

I. General information

NPI: 1033414917
Provider Name (Legal Business Name): THE CENTER FOR INTEGRATIVE HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2011
Last Update Date: 01/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

484 S MILLER RD SUITE 202
FAIRLAWN OH
44333-4176
US

IV. Provider business mailing address

484 S MILLER RD SUITE 202
FAIRLAWN OH
44333-4176
US

V. Phone/Fax

Practice location:
  • Phone: 330-835-4545
  • Fax: 330-835-4575
Mailing address:
  • Phone: 330-835-4545
  • Fax: 330-835-4575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number35069584
License Number StateOH

VIII. Authorized Official

Name: DR. MATTHEW DAVID MCDANIEL
Title or Position: OWNER
Credential: MD
Phone: 330-835-4545