Provider Demographics
NPI:1972798064
Name:INTEGRATIVE THERAPIES, LTD.
Entity type:Organization
Organization Name:INTEGRATIVE THERAPIES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:REYNES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-771-3471
Mailing Address - Street 1:7756 MADISON ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-2058
Mailing Address - Country:US
Mailing Address - Phone:708-771-3471
Mailing Address - Fax:708-771-2553
Practice Address - Street 1:7756 MADISON ST
Practice Address - Street 2:SUITE 8
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-2058
Practice Address - Country:US
Practice Address - Phone:708-771-3471
Practice Address - Fax:708-771-2553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL706770Medicare PIN