Provider Demographics
NPI:1871946400
Name:INTEGRATIVE CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:INTEGRATIVE CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:CONRAD
Authorized Official - Last Name:MUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:713-340-8248
Mailing Address - Street 1:1911 W ALABAMA ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-2737
Mailing Address - Country:US
Mailing Address - Phone:713-340-8248
Mailing Address - Fax:
Practice Address - Street 1:1911 W ALABAMA ST
Practice Address - Street 2:SUITE A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-2737
Practice Address - Country:US
Practice Address - Phone:713-340-8248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty