=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295865863
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DUNKERLEY CHIROPRACTIC CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2007
-----------------------------------------------------
Last Update Date | 07/26/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7433 WARREN SHARON RD
-----------------------------------------------------
City | BROOKFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44403-9660
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-448-1060
-----------------------------------------------------
Fax | 330-448-1574
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 531
-----------------------------------------------------
City | BROOKFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44403-0531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-448-1060
-----------------------------------------------------
Fax | 330-448-1574
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. CHRALES EDWIN DUNKERLEY
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 330-448-1060
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 1133
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------