=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033467725
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MCCOWN CHIROPRACTIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2012
-----------------------------------------------------
Last Update Date | 08/28/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1710 ALLEN STREET
-----------------------------------------------------
City | KELSO
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98626-0070
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-577-0294
-----------------------------------------------------
Fax | 360-577-2635
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1710 ALLEN STREET (MAILING PO BOX 809)
-----------------------------------------------------
City | KELSO
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 68626-0070
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-577-0294
-----------------------------------------------------
Fax | 360-577-2635
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER/OWNER
-----------------------------------------------------
Name | MR. WILLIAM NELSON MCCOWN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 360-577-0294
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH00002167
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------