Integrative Physical Medicine of Leesburg, LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

INTEGRATIVE PHYSICAL MEDICINE OF LEESBURG, LLC

Practice address

106 W North Blvd Ste 101
Leesburg, FL 34748-5039

Phone

(321) 318-6758

NPI assigned

Mar 12, 2019

Organization subpart

No

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

Authorized official

Name

Marc Ott, DC

Title

Ceo

Phone

(352) 702-4250

Specialties & licenses 1

Addresses

Other names 1

• Integrative Physical Medicine Doing business as

Locations

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

{
    "created_epoch": "1552348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565568000000",
    "number": "1487112173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 ALEXANDRIA BLVD STE 1000",
            "city": "OVIEDO",
            "state": "FL",
            "postal_code": "327655548",
            "telephone_number": "321-318-6758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 W NORTH BLVD STE 101",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347485039",
            "telephone_number": "321-318-6758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATIVE PHYSICAL MEDICINE OF LEESBURG, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-12",
        "last_updated": "2019-08-12",
        "status": "A",
        "authorized_official_last_name": "OTT",
        "authorized_official_first_name": "MARC",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "352-702-4250",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Integrative Physical Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Integrative Physical Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Chiropractor in Leesburg, FL
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2019; 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.