=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316107105
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASHLEY LOGAN TREADWAY DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2008
-----------------------------------------------------
Last Update Date | 06/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1175 VINE ST
-----------------------------------------------------
City | BATESVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72501-3526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-793-4177
-----------------------------------------------------
Fax | 870-796-6433
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1175 VINE ST
-----------------------------------------------------
City | BATESVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72501-3526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-793-4177
-----------------------------------------------------
Fax | 870-796-6433
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | APPLIED FOR
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------