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General NPI Number Information
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NPI Number | 1235632100
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Entity Type | Organization
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Legal Business Name | INTEGRAL CHIROPRACTIC CO
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Dates
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Enumeration Date | 03/16/2018
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Last Update Date | 03/16/2018
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Provider Practice Location Address
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Address Line | 3101 BROWNS MILL RD STE 16
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City | JOHNSON CITY
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State | TN
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Zip | 37604-4100
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Country | US
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Telephone | 423-299-1895
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Fax | 423-299-1895
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Provider Business Mailing Address
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Address Line | 3101 BROWNS MILL RD STE 16
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City | JOHNSON CITY
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State | TN
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Zip | 37604-4100
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Country | US
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Telephone | 423-299-1895
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Fax | 423-299-1895
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL BRYAN
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Credential | DC
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Telephone | 423-299-1895
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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 | 3090
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License Number State | TN
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