1710042031 NPI number — INTEGRATED HEALTHCARE CENTER, LLC

Table of content: (NPI 1710042031)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710042031 NPI number — INTEGRATED HEALTHCARE CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRATED HEALTHCARE CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MOUNTAIN TOP CHIROPRACTIC AND NUTRITION CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710042031
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1627 MERIDEN RD # A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOLCOTT
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06716-3231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-879-7246
Provider Business Mailing Address Fax Number:
203-879-9340

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1627 MERIDEN RD # A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOLCOTT
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06716-3231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-879-7246
Provider Business Practice Location Address Fax Number:
203-879-9340
Provider Enumeration Date:
12/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHOJNACKI
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
203-879-7246

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  001404 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: 001401 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1821104720 . This is a "NPI #, DR. CHOJNACKI" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1841300860 . This is a "NPI #, DR. SWIERCZYNSKI" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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