Provider Demographics
NPI:1316083975
Name:INTEGRATIVE CHIROPRACTIC PC
Entity type:Organization
Organization Name:INTEGRATIVE CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:PALAZZO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-468-5622
Mailing Address - Street 1:4089 DAVIS DRIVE
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560
Mailing Address - Country:US
Mailing Address - Phone:919-468-5622
Mailing Address - Fax:919-468-5624
Practice Address - Street 1:4089 DAVIS DRIVE
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560
Practice Address - Country:US
Practice Address - Phone:919-468-5622
Practice Address - Fax:919-468-5622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3698111N00000X
NC4285111N00000X
NC3644111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5907348Medicaid
NC5907348Medicaid
NC2459325Medicare PIN