Healthcare Provider Details

I. General information

NPI: 1356472302
Provider Name (Legal Business Name): INTEGRAL CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 11/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 B PARKMONT LN SW, STE A
OLYMPIA WA
98502-1048
US

IV. Provider business mailing address

2625 B PARKMONT LN SW, STE A
OLYMPIA WA
98502-1048
US

V. Phone/Fax

Practice location:
  • Phone: 360-943-2940
  • Fax: 360-943-5616
Mailing address:
  • Phone: 360-943-2940
  • Fax: 360-943-5616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00034084
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00006430
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00008767
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00015063
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60065983
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60066736
License Number StateWA

VIII. Authorized Official

Name: DR. MICHAEL WELLS NEELY
Title or Position: CHIROPRACTOR - OWNER
Credential: DC
Phone: 360-943-2940