# LAKE NORMAN INTEGRATIVE WELLNESS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356961007
- **Authorized official:** DR. AKIBA JOSEPH GREEN DC, DNM (CLINIC DIRECTOR)
- **Authorized official phone:** (704) 658-7350

## Contact information

- **Practice address:** 21000 TORRENCE CHAPEL RD STE 101, CORNELIUS, NC 28031-6874
- **Practice address phone:** (704) 987-3993
- **Practice address fax:** (704) 987-3991
- **Mailing address:** 21000 TORRENCE CHAPEL RD STE 101, CORNELIUS, NC 28031-6874
- **Mailing address phone:** (704) 987-3993
- **Mailing address fax:** (704) 987-3991

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 04/23/2020
- **Last updated:** 04/23/2020