# INTEGRATED BODY AND MEDICINE, PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Kennedy Ave Chiropractic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407404569
- **Authorized official:** DR. AHMAD SPROUSE DC (OWNER)
- **Authorized official phone:** (219) 803-6630

## Contact information

- **Practice address:** 8145 KENNEDY AVE, HIGHLAND, IN 46322-1128
- **Practice address phone:** (219) 803-6630
- **Practice address fax:** (219) 937-7237
- **Mailing address:** 8145 KENNEDY AVE, HIGHLAND, IN 46322-1128
- **Mailing address phone:** (219) 803-6630
- **Mailing address fax:** (219) 937-7237

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/30/2019
- **Last updated:** 03/01/2022