=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164602280
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM L INGLE DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2007
-----------------------------------------------------
Last Update Date | 07/14/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 321 N JEBAVY DR
-----------------------------------------------------
City | LUDINGTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49431-1923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-843-4088
-----------------------------------------------------
Fax | 231-845-2753
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 321 N JEBAVY DR
-----------------------------------------------------
City | LUDINGTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49431-1923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-843-4088
-----------------------------------------------------
Fax | 231-845-2753
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2301005648
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------