=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023295219
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | QUALLS FAMILY CHIROPRACTIC INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2008
-----------------------------------------------------
Last Update Date | 01/30/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1629 ASHLAND RD STE 4
-----------------------------------------------------
City | GREENUP
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41144-1249
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-473-2132
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 577
-----------------------------------------------------
City | GREENUP
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41144-0577
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-473-2132
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/D.C.
-----------------------------------------------------
Name | DR. DANIEL JASON QUALLS
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 606-473-2132
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------