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General NPI Number Information
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NPI Number | 1326207259
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE CHIROPRACTIC & WELLNESS, LLC
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Dates
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Enumeration Date | 06/05/2008
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Last Update Date | 06/05/2008
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Provider Practice Location Address
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Address Line | 7756 MADISON ST SUITE 8
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City | RIVER FOREST
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State | IL
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Zip | 60305-2058
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Country | US
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Telephone | 708-711-3471
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Fax |
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Provider Business Mailing Address
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Address Line | 106 CALENDAR CT SUITE 94
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City | LA GRANGE
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State | IL
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Zip | 60525-2325
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Country | US
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Telephone | 708-771-3471
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. PAUL DAVID MICHAELS
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Credential | D.C.
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Telephone | 708-771-3471
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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 | 038008307
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License Number State | IL
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