MEDICARE: INTEGRATIVE HEALTH AND WELLNESS 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	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1578309100
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATIVE HEALTH AND WELLNESS LLC

Provider Business Mailing Address
First Line	:	552 FORT EVANS RD STE 309
Second Line	:
City	:	LEESBURG
State	:	VA
Zip	:	20176-3378
Country	:	US
Telephone Number	:	703-771-3204
Fax Number	:	703-771-3273

Provider Business Practice Location Address
First Line	:	552 FORT EVANS RD STE 309
Second Line	:
City	:	LEESBURG
State	:	VA
Zip	:	20176-3378
Country	:	US
Telephone Number	:	703-771-3204
Fax Number	:	703-771-3273

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	KEITH BRASSFIELD
Credential	:	DC
Telephone Number	:	703-771-3204

Provider Enumeration Date	:	07/03/2024
Last Update Date	:	07/07/2025

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