=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033518519
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ISON CHIROPRACTIC PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2014
-----------------------------------------------------
Last Update Date | 08/20/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3740 CLEVELAND HEIGHTS BLVD
-----------------------------------------------------
City | LAKELAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33813-1215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-646-5707
-----------------------------------------------------
Fax | 863-647-5044
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3740 CLEVELAND HEIGHTS BLVD
-----------------------------------------------------
City | LAKELAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33813-1215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-646-5707
-----------------------------------------------------
Fax | 863-647-5044
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTIC PHYSICIAN
-----------------------------------------------------
Name | DR. ALEXANDER SCOTT ISON
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 863-646-5707
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH11215
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------