NPIMap

Organization Active NPI

Integrated Life, LLC

  • Chiropractor
  • Charlottesville, VA
National Provider Identifier
1821453721
Registry record updated Dec 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
0104001870 Issued in VA
Legal business name
INTEGRATED LIFE, LLC
Practice address
103 S Pantops Dr
Suite 105
Charlottesville, VA 22911-8617
Phone
(434) 227-7149
NPI assigned
Dec 18, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2015

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

Authorized official

Name
Dr. Brian P Dickert, D.C.
Title
Owner
Phone
(434) 227-7149

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 0104001870 VA Primary

Addresses

Primary practice location

103 S Pantops Dr
Suite 105
Charlottesville, VA 22911-8617

Mailing address

103 South Pantops Dr.
Suite 105
Charlottesville, VIRGINIA 22911
UM
Phone (434) 227-7149

National Provider Directory

National Provider Directory

Locations

103 S Pantops Dr
Ste 105
Charlottesville, VA 22911
Phone (434) 227-7149

NPI Registry JSON

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

{
    "created_epoch": "1450396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450396800000",
    "number": "1821453721",
    "addresses": [
        {
            "country_code": "UM",
            "country_name": "United States Minor Outlying Islands",
            "address_purpose": "MAILING",
            "address_type": "FGN",
            "address_1": "103 SOUTH PANTOPS DR.",
            "address_2": "SUITE 105",
            "city": "CHARLOTTESVILLE",
            "state": "VIRGINIA",
            "postal_code": "22911",
            "telephone_number": "434-227-7149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 S PANTOPS DR",
            "address_2": "SUITE 105",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229118617",
            "telephone_number": "434-227-7149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED LIFE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-18",
        "last_updated": "2015-12-18",
        "status": "A",
        "authorized_official_last_name": "DICKERT",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "434-227-7149",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "VA",
            "license": "0104001870",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlottesville, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2015; 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.