=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124195326
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IN PULSE CHIROPRACTIC PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2006
-----------------------------------------------------
Last Update Date | 07/23/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1212 E BASELINE RD SUITE 100
-----------------------------------------------------
City | TEMPE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85283-1404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-449-3300
-----------------------------------------------------
Fax | 480-820-1188
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1212 E BASELINE RD SUITE 100
-----------------------------------------------------
City | TEMPE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85283-1404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-449-3300
-----------------------------------------------------
Fax | 480-820-1188
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DAVID MICHAEL ISRAEL
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 480-449-3300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2003
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------