=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063618007
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | K.W. FIELDS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2007
-----------------------------------------------------
Last Update Date | 07/17/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4700 FM 2920 RD STE 1
-----------------------------------------------------
City | SPRING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77388-3109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-353-3544
-----------------------------------------------------
Fax | 281-288-5566
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4700 FM 2920 RD STE 1
-----------------------------------------------------
City | SPRING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77388-3109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-353-3544
-----------------------------------------------------
Fax | 281-288-5566
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KENNETH WAYNE FIELDS
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 281-353-3544
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 2435
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------