=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225216336
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROGRESSIVE CHIROPRACTIC CENTER, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2008
-----------------------------------------------------
Last Update Date | 05/19/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1549 N BURK ST STE 100
-----------------------------------------------------
City | GILBERT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85234-2483
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-497-2642
-----------------------------------------------------
Fax | 480-497-1863
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1549 N BURK ST STE 100
-----------------------------------------------------
City | GILBERT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85234-2483
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-497-2642
-----------------------------------------------------
Fax | 480-497-1863
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE ADMINISTRATOR
-----------------------------------------------------
Name | MS. GINGER HOPKINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 480-636-4266
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 4490
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------