NPIMap

Organization Active NPI

Integrated Healthcare of Montclair, LLC

  • Chiropractor
  • Montclair, NJ
National Provider Identifier
1063770477
Registry record updated Apr 24, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
38MC00543600 Issued in NJ
Legal business name
INTEGRATED HEALTHCARE OF MONTCLAIR, LLC
Practice address
295 Bloomfield Ave
Commercial Suite 1
Montclair, NJ 07042-3643
Phone
(973) 744-1155
NPI assigned
Apr 24, 2012
Last updated
Apr 24, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Tyran G Mincey, D.C.NPI 1770661647
Title
President
Phone
(973) 744-1155

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 38MC00543600 NJ Primary

Addresses

Primary practice location

295 Bloomfield Ave
Commercial Suite 1
Montclair, NJ 07042-3643

Mailing address

295 Bloomfield Ave
Commercial Suite 1
Montclair, NJ 07042-3643
Phone (973) 744-1155

Other names 1

  • Integrated Healthcare Other name

National Provider Directory

National Provider Directory

Locations

295 Bloomfield Ave
Ste 1
Montclair, NJ 07042
Phone (973) 744-1155

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1335225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335225600000",
    "number": "1063770477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "295 BLOOMFIELD AVE",
            "address_2": "COMMERCIAL SUITE 1",
            "city": "MONTCLAIR",
            "state": "NJ",
            "postal_code": "070423643",
            "telephone_number": "973-744-1155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "295 BLOOMFIELD AVE",
            "address_2": "COMMERCIAL SUITE 1",
            "city": "MONTCLAIR",
            "state": "NJ",
            "postal_code": "070423643",
            "telephone_number": "973-744-1155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED HEALTHCARE OF MONTCLAIR, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-24",
        "last_updated": "2012-04-24",
        "status": "A",
        "authorized_official_last_name": "MINCEY",
        "authorized_official_first_name": "TYRAN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "973-744-1155",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "NJ",
            "license": "38MC00543600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Integrated Healthcare",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Montclair, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.