=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225338783
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NATURAL HEALTH CHIROPRACTIC SPORT & SPINE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2010
-----------------------------------------------------
Last Update Date | 10/29/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4634 CAMP BOWIE BLVD
-----------------------------------------------------
City | FT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76107-3744
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-735-3839
-----------------------------------------------------
Fax | 817-735-3837
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4634 CAMP BOWIE BLVD
-----------------------------------------------------
City | FT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76107-3744
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-735-3839
-----------------------------------------------------
Fax | 817-735-3837
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | BRIAN RONALD SAUL
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 817-735-3839
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NS0005X
-----------------------------------------------------
Taxonomy Name | Sports Physician Chiropractor
-----------------------------------------------------
License Number | 9203
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------