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General NPI Number Information
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NPI Number | 1194989715
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE PAIN MANAGEMENT, LLC
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Dates
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Enumeration Date | 07/13/2008
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Last Update Date | 03/11/2016
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Provider Practice Location Address
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Address Line | 1858 E SOUTHERN AVE
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City | TEMPE
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State | AZ
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Zip | 85282-5836
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Country | US
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Telephone | 480-858-1868
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Fax | 480-838-8887
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Provider Business Mailing Address
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Address Line | 1858 E SOUTHERN AVE
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City | TEMPE
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State | AZ
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Zip | 85282-5836
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Country | US
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Telephone | 480-858-1868
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Fax | 480-838-8887
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. GREGORY KATSAROS
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Credential | D.C.
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Telephone | 480-858-1868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 5311
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License Number State | AZ
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