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General NPI Number Information
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NPI Number | 1770646937
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Entity Type | Organization
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Legal Business Name | INTEGRACARE LTD
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 08/29/2023
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Provider Practice Location Address
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Address Line | 100 2ND ST S
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City | SARTELL
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State | MN
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Zip | 56377-1977
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Country | US
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Telephone | 320-251-2600
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Fax | 320-251-4763
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Provider Business Mailing Address
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Address Line | 100 2ND ST S PO BOX 296
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City | SARTELL
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State | MN
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Zip | 56377-1977
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Country | US
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Telephone | 320-251-2600
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Fax | 320-251-4763
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Authorized Official
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Title or Position | MEDICAL DIRECTOR MEDICAL DOCTOR
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Name | MR. MARK RANDY HALSTROM
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Credential | MD
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Telephone | 320-251-2600
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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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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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