Provider Demographics
NPI:1285887521
Name:INTEGRATED HEALTH AND PERFORMANCE SYSTEMS, PA
Entity type:Organization
Organization Name:INTEGRATED HEALTH AND PERFORMANCE SYSTEMS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-826-3808
Mailing Address - Street 1:1449 YAMATO RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-4471
Mailing Address - Country:US
Mailing Address - Phone:561-826-3808
Mailing Address - Fax:561-826-3806
Practice Address - Street 1:1449 YAMATO RD
Practice Address - Street 2:SUITE 2
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-4471
Practice Address - Country:US
Practice Address - Phone:561-826-3808
Practice Address - Fax:561-826-3806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-30
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9631111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty