=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295831832
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FALLS CHIROPRACTIC CLINIC, LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2006
-----------------------------------------------------
Last Update Date | 08/28/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 440 4TH ST
-----------------------------------------------------
City | INTERNATIONAL FALLS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56649-2414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-285-7428
-----------------------------------------------------
Fax | 218-285-7429
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 440 4TH ST
-----------------------------------------------------
City | INTERNATIONAL FALLS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56649-2414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-285-7428
-----------------------------------------------------
Fax | 218-285-7429
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MICHAEL MONROE CARNEY
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 218-285-7428
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 1636
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------