Provider Demographics
NPI:1962698381
Name:INTEGRATED HEALTH CENTER LLC
Entity type:Organization
Organization Name:INTEGRATED HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:JEREMIAH
Authorized Official - Last Name:STINEMETZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-994-5222
Mailing Address - Street 1:PO BOX 715
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43014-0715
Mailing Address - Country:US
Mailing Address - Phone:740-599-7562
Mailing Address - Fax:740-599-6166
Practice Address - Street 1:226 E BURWELL AVE
Practice Address - Street 2:
Practice Address - City:LOUDONVILLE
Practice Address - State:OH
Practice Address - Zip Code:44842-9504
Practice Address - Country:US
Practice Address - Phone:419-994-5222
Practice Address - Fax:419-994-4443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC3106111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3103733Medicaid
OH000000230223OtherANTHEM BC/BS OF OHIO
OH000000230223OtherANTHEM BC/BS OF OHIO