Provider Demographics
NPI:1194052316
Name:INTEGRATED PHYSICAL MEDICINE, LLC
Entity type:Organization
Organization Name:INTEGRATED PHYSICAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-739-2225
Mailing Address - Street 1:4216 CORTEZ RD W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-3121
Mailing Address - Country:US
Mailing Address - Phone:941-739-2225
Mailing Address - Fax:941-753-6821
Practice Address - Street 1:4216 CORTEZ RD W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3121
Practice Address - Country:US
Practice Address - Phone:941-739-2225
Practice Address - Fax:941-753-6821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-09
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000HGOtherBCBS
FL000HGOtherBCBS