=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326122334
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW BEGINNINGS CHIROPRACTIC, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21050 N TATUM BLVD SUITE# 200
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85050-4260
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-515-5432
-----------------------------------------------------
Fax | 480-515-5444
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21050 N TATUM BLVD SUITE# 200
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85050-4260
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-515-5432
-----------------------------------------------------
Fax | 480-515-5444
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MARCY JAMES DIONISIO
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 480-515-5432
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC4998
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------