=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255797585
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DOLLISON CHIROPRACTIC OFFICE, LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/31/2015
-----------------------------------------------------
Last Update Date | 12/31/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 S 9TH ST
-----------------------------------------------------
City | CAMBRIDGE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43725-2854
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-439-9393
-----------------------------------------------------
Fax | 740-439-9395
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 S 9TH ST
-----------------------------------------------------
City | CAMBRIDGE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43725-2854
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-439-9393
-----------------------------------------------------
Fax | 740-439-9395
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CHIROPRACTOR
-----------------------------------------------------
Name | DR. CARL RICHARD DOLLISON
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 740-439-9393
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | OH1731
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------