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General NPI Number Information
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NPI Number | 1184085201
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE HEALING CENTER, LLC
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Dates
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Enumeration Date | 03/17/2016
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Last Update Date | 03/17/2016
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Provider Practice Location Address
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Address Line | 6019 FINCHAM DRIVE
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City | ROCKFORD
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State | IL
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Zip | 61108
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Country | US
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Telephone | 219-902-7340
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Fax |
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Provider Business Mailing Address
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Address Line | 2509 MANDRAKE DRIVE
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City | ROCKFORD
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State | IL
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Zip | 61108
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Country | US
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Telephone | 219-902-7340
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ELISHA ROBINSON
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Credential | M.D.
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Telephone | 219-902-7340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 036.130252
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License Number State | IL
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