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General NPI Number Information
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NPI Number | 1417416363
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE CHIROPRACTIC & REHABILITATION
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Dates
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Enumeration Date | 03/19/2019
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Last Update Date | 03/19/2019
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Provider Practice Location Address
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Address Line | 7050 OAKLAND MILLS RD
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City | COLUMBIA
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State | MD
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Zip | 21046-2193
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Country | US
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Telephone | 240-460-4566
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Fax |
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Provider Business Mailing Address
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Address Line | 11402 SHERRIE LN
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City | SILVER SPRING
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State | MD
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Zip | 20902-2664
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Country | US
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Telephone | 240-460-4566
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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. CHRISTINA LEE
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Credential | DC
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Telephone | 240-460-4566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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