=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316193469
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AUGUSTA FAMILY CHIROPRACTIC, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2008
-----------------------------------------------------
Last Update Date | 02/14/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 701 BELMONT AVE
-----------------------------------------------------
City | AUGUSTA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67010-2256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-775-7779
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 701 BELMONT AVE
-----------------------------------------------------
City | AUGUSTA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67010-2256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-775-7779
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ALYSON RENEE SMITH
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 316-775-7779
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 01-04867
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------