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General NPI Number Information
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NPI Number | 1013681444
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Entity Type | Organization
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Legal Business Name | INTEGRATED HEALTH AND WELLNESS CENTER INC
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Dates
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Enumeration Date | 08/09/2021
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Last Update Date | 08/09/2021
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Provider Practice Location Address
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Address Line | 22 W COLT SQUARE DR
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-2813
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Country | US
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Telephone | 479-582-5900
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Fax | 479-582-0569
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Provider Business Mailing Address
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Address Line | 22 W COLT SQUARE DR
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-2813
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Country | US
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Telephone | 479-582-5900
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Fax | 479-582-0569
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Authorized Official
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Title or Position | OWNER
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Name | LUCAS J VAN DER MERWE
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Credential |
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Telephone | 479-582-5900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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