=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285045021
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BODYFIT CHIROPRACTIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2014
-----------------------------------------------------
Last Update Date | 05/14/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 406 SE 131ST AVE STE 108
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98683-4031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-944-0050
-----------------------------------------------------
Fax | 360-885-1212
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 406 SE 131ST AVE STE 108
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98683-4031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-944-0050
-----------------------------------------------------
Fax | 360-885-1212
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. PERRY H GUYTON III
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 360-944-0050
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MA 60170179
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------