=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285034736
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DO A BODY GOOD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2014
-----------------------------------------------------
Last Update Date | 09/02/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 144 NEPTUNE PL
-----------------------------------------------------
City | ESCONDIDO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92026-2076
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-500-1123
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 144 NEPTUNE PL
-----------------------------------------------------
City | ESCONDIDO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92026-2076
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-500-1123
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER
-----------------------------------------------------
Name | DR. LISA ERIN WHITE
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 760-500-1123
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 19330
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------