=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003181884
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAMES ALLEN CHIROPRACTIC, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2012
-----------------------------------------------------
Last Update Date | 06/15/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 27772 VISTA DEL LAGO # B14
-----------------------------------------------------
City | MISSION VIEJO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92692-1173
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-544-0333
-----------------------------------------------------
Fax | 949-544-0324
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27772 VISTA DEL LAGO # B14
-----------------------------------------------------
City | MISSION VIEJO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92692-1173
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-544-0333
-----------------------------------------------------
Fax | 949-544-0324
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JAMES ALLEN III
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 949-544-0333
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NR0200X
-----------------------------------------------------
Taxonomy Name | Radiology Chiropractor
-----------------------------------------------------
License Number | DC31583
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------