Integrated Healthcare of Montclair, LLC

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

Organization subpart

No

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.

Title

President

Phone

(973) 744-1155

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Integrated Healthcare Other name

Locations

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": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1770661647",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Integrated Healthcare",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Chiropractor in Montclair, NJ
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• Chiropractor in New Jersey

• 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.