=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104119080
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TARRYTOWN CHIROPRACTIC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2011
-----------------------------------------------------
Last Update Date | 05/25/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 102 S BROADWAY
-----------------------------------------------------
City | TARRYTOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10591-4006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-631-4900
-----------------------------------------------------
Fax | 914-332-1362
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 102 S BROADWAY
-----------------------------------------------------
City | TARRYTOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10591-4006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-631-4900
-----------------------------------------------------
Fax | 914-332-1362
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MICHAEL PAULE
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 914-631-4900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NN1001X
-----------------------------------------------------
Taxonomy Name | Nutrition Chiropractor
-----------------------------------------------------
License Number | X006879-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------