MEDICARE: INTEGRATED MEDICAL CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1053686329
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED MEDICAL CENTER LLC

Provider Business Mailing Address
First Line	:	8214 CENTREVILLE RD
Second Line	:
City	:	MANASSAS
State	:	VA
Zip	:	20111-2226
Country	:	US
Telephone Number	:	703-396-7770
Fax Number	:	703-396-7008

Provider Business Practice Location Address
First Line	:	8214 CENTREVILLE RD
Second Line	:
City	:	MANASSAS
State	:	VA
Zip	:	20111-2226
Country	:	US
Telephone Number	:	703-396-7770
Fax Number	:	703-396-7008

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEVE LININGER
Credential	:
Telephone Number	:	703-396-7770

Provider Enumeration Date	:	03/20/2012
Last Update Date	:	03/20/2012

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