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General NPI Number Information
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NPI Number | 1023457066
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Entity Type | Organization
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Legal Business Name | COME ALIVE CHIROPRACTIC LLC
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Dates
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Enumeration Date | 06/24/2013
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Last Update Date | 06/24/2013
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Provider Practice Location Address
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Address Line | 358 BEXLEY CT
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City | MASON
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State | OH
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Zip | 45040-2215
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Country | US
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Telephone | 513-258-1227
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Fax |
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Provider Business Mailing Address
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Address Line | 358 BEXLEY CT
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City | MASON
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State | OH
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Zip | 45040-2215
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Country | US
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Telephone | 513-258-1227
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Fax |
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Authorized Official
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Title or Position | PART OWNER
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Name | DR. JAMES GREGORY WASHAM JR.
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Credential | DC
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Telephone | 513-258-1227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1489
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License Number State | OH
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