Organization
INTEGRATED MEDICAL GROUP LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID THAYER DC (OWNER)
(618) 692-6700
Entity
Organization
Contact information
Practice address
435 S BUCHANAN ST STE B, EDWARDSVILLE, IL 62025-2091
(618) 692-6700
(618) 692-6711
Mailing address
PO BOX 997, EDWARDSVILLE, IL 62025-0997
(618) 692-6700
(618) 692-6711
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
038009512
IL
111N00000X
Chiropractor
Primary
038010423
IL
111N00000X
Chiropractor
038010464
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
583609003
DME NUMBER
IL
Enumeration date
09/15/2006
Last updated
07/11/2008
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