=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255568937
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BUTTON-WELLER CHIROPRACTIC DC PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2009
-----------------------------------------------------
Last Update Date | 09/08/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 446 S MAIN ST
-----------------------------------------------------
City | MONTROSE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18801-1353
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-278-1134
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 446 S MAIN ST
-----------------------------------------------------
City | MONTROSE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18801-1353
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-278-1134
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JENNIFER BUTTON-WELLER
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 570-278-1134
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 080991953
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------