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General NPI Number Information
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NPI Number | 1417412750
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Entity Type | Organization
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Legal Business Name | NOVA INTEGRATED HEALTH, PC
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Dates
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Enumeration Date | 01/31/2019
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Last Update Date | 01/31/2019
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Provider Practice Location Address
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Address Line | 2675 N ANKENY BLVD STE 113
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City | ANKENY
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State | IA
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Zip | 50023-4719
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Country | US
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Telephone | 515-289-4549
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Fax |
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Provider Business Mailing Address
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Address Line | 1103 RIDGETOP DR
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City | HUXLEY
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State | IA
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Zip | 50124-4704
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER, CEO
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Name | TAYLOR VANDEN WYNBOOM
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Credential | DC
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Telephone | 515-289-4549
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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