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General NPI Number Information
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NPI Number | 1043555840
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Entity Type | Organization
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Legal Business Name | INTEGRATED HEALTH & WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 12/05/2012
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Last Update Date | 12/05/2012
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Provider Practice Location Address
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Address Line | 103 3RD AVE NE
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City | FREEPORT
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State | MN
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Zip | 56331-9017
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Country | US
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Telephone | 320-836-7150
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Fax | 320-836-7162
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Provider Business Mailing Address
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Address Line | 103 3RD AVE NE P.O. BOX 309
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City | FREEPORT
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State | MN
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Zip | 56331-9017
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Country | US
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Telephone | 320-836-7150
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Fax | 320-836-7162
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Authorized Official
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Title or Position | OWNER
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Name | DR. DEBRA J PROECHEL
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Credential | D.C.
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Telephone | 320-836-7150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | 2403
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License Number State | MN
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