=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306382130
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALIGN THE SPINE CHIROPRACTIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2017
-----------------------------------------------------
Last Update Date | 01/18/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1360 S PATRICK DR SUITE 7
-----------------------------------------------------
City | SATELLITE BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32937-4316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-769-4380
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1503B ATLANTIC ST
-----------------------------------------------------
City | MELBOURNE BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32951-2326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-769-4380
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ANNALIESE DENNIS
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 941-769-4380
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------