=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174894497
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAYLERPARK CHIROPRACTIC INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2012
-----------------------------------------------------
Last Update Date | 01/18/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6581 GRACELY DR
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45233-1242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-941-6650
-----------------------------------------------------
Fax | 513-941-6652
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6581 GRACELY DR
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45233-1242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-941-6650
-----------------------------------------------------
Fax | 513-941-6652
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. LAWRENCE E WELLS
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 513-941-6650
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Chiropractor
-----------------------------------------------------
License Number | 3146
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------