=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053697870
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EAST-WEST CHIROPRACTIC & REHABILITATION OF HUDSON
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2011
-----------------------------------------------------
Last Update Date | 10/25/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13315 US HIGHWAY 19
-----------------------------------------------------
City | HUDSON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34667-1659
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-378-8570
-----------------------------------------------------
Fax | 727-857-6074
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13315 US HIGHWAY 19
-----------------------------------------------------
City | HUDSON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34667-1659
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-378-8570
-----------------------------------------------------
Fax | 727-857-6074
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN/OWNER
-----------------------------------------------------
Name | DR. MAYUR M RESHAMWALA
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 727-378-8570
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Chiropractor
-----------------------------------------------------
License Number | CH9063
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------