=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104015270
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRUE FAMILY CHIROPRACTIC, PSC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2007
-----------------------------------------------------
Last Update Date | 02/24/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 262 E STEVE WARINER DR
-----------------------------------------------------
City | RUSSELL SPRINGS
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42642-4225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-866-7246
-----------------------------------------------------
Fax | 270-866-7266
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 262 E STEVE WARINER DR
-----------------------------------------------------
City | RUSSELL SPRINGS
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42642-4225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-866-7246
-----------------------------------------------------
Fax | 270-866-7266
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MATTHEW MICHAEL TRUE
-----------------------------------------------------
Credential | D.C
-----------------------------------------------------
Telephone | 270-866-7246
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 4917
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------