MEDICARE: INTEGRATIVE PAIN MANAGEMENT, 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	5311	AZ

General Provider Information

NPI Number	:	1194989715
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATIVE PAIN MANAGEMENT, LLC

Provider Business Mailing Address
First Line	:	1858 E SOUTHERN AVE
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-5836
Country	:	US
Telephone Number	:	480-858-1868
Fax Number	:	480-838-8887

Provider Business Practice Location Address
First Line	:	1858 E SOUTHERN AVE
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-5836
Country	:	US
Telephone Number	:	480-858-1868
Fax Number	:	480-838-8887

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. GREGORY KATSAROS
Credential	:	D.C.
Telephone Number	:	480-858-1868

Provider Enumeration Date	:	07/13/2008
Last Update Date	:	03/11/2016

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