MEDICARE: INTEGRITY BACK AND BRAIN LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1568134864
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRITY BACK AND BRAIN LLC

Provider Business Mailing Address
First Line	:	8849 PINE ISLAND CT S
Second Line	:
City	:	MATTAWAN
State	:	MI
Zip	:	49071-9570
Country	:	US
Telephone Number	:	269-348-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	8849 PINE ISLAND CT S
Second Line	:
City	:	MATTAWAN
State	:	MI
Zip	:	49071-9570
Country	:	US
Telephone Number	:	269-348-7000
Fax Number	:	269-924-0675

Authorized Official
Title or Position	:	MEMBER
Name	:	ADAM GRASSL
Credential	:
Telephone Number	:	269-348-7000

Provider Enumeration Date	:	10/05/2021
Last Update Date	:	10/05/2021

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