Healthcare Provider Details

I. General information

NPI: 1366745739
Provider Name (Legal Business Name): INTEGRITY MEDICAL GROUP LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2010
Last Update Date: 12/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3055 W ARMITAGE AVE
CHICAGO IL
60647-3862
US

IV. Provider business mailing address

PO BOX 388328
CHICAGO IL
60638-8328
US

V. Phone/Fax

Practice location:
  • Phone: 773-938-1838
  • Fax: 773-767-3944
Mailing address:
  • Phone: 773-938-1838
  • Fax: 773-767-3944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038010670
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038008711
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number036122087
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number038011741
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number070014443
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number036084127
License Number StateIL
# 7
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number036112063
License Number StateIL

VIII. Authorized Official

Name: LYNNETTE MCROY
Title or Position: BILLING COORDINATOR
Credential:
Phone: 773-767-3822