Healthcare Provider Details

I. General information

NPI: 1962698381
Provider Name (Legal Business Name): INTEGRATED HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 E BURWELL AVE
LOUDONVILLE OH
44842-9504
US

IV. Provider business mailing address

PO BOX 715
DANVILLE OH
43014-0715
US

V. Phone/Fax

Practice location:
  • Phone: 419-994-5222
  • Fax: 419-994-4443
Mailing address:
  • Phone: 740-599-7562
  • Fax: 740-599-6166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC3106
License Number StateOH

VIII. Authorized Official

Name: DR. NATHAN JEREMIAH STINEMETZ
Title or Position: PHYSICIAN
Credential: DC
Phone: 419-994-5222