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General NPI Number Information
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NPI Number | 1285889428
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE FAMILY WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 12/01/2008
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Last Update Date | 01/23/2009
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Provider Practice Location Address
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Address Line | 16535 W BLUEMOUND RD STE 222
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City | BROOKFIELD
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State | WI
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Zip | 53005-5906
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Country | US
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Telephone | 262-754-4910
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Fax | 262-754-4913
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Provider Business Mailing Address
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Address Line | 16535 W BLUEMOUND RD STE 222
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City | BROOKFIELD
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State | WI
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Zip | 53005-5906
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Country | US
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Telephone | 262-754-4910
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Fax | 262-754-4913
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Authorized Official
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Title or Position | OWNER
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Name | MICHELE NICKELS
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Credential |
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Telephone | 262-754-4910
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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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