=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083860068
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUNRISE CHIROPRACTIC CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2008
-----------------------------------------------------
Last Update Date | 01/24/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 966 COMMERCIAL DR
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40475-3402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-625-9791
-----------------------------------------------------
Fax | 859-625-7840
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 966 COMMERCIAL DR
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40475-3402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-625-9791
-----------------------------------------------------
Fax | 859-625-7840
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT OF CORPORATION
-----------------------------------------------------
Name | DR. DANNY M. MCCASLIN
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 859-625-9791
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 3991
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------