=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336132299
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MLPA INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 29 CRESCENT ST
-----------------------------------------------------
City | FRONT ROYAL
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22630-3328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-635-1270
-----------------------------------------------------
Fax | 540-635-2732
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29 CRESCENT ST
-----------------------------------------------------
City | FRONT ROYAL
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22630-3328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-635-1270
-----------------------------------------------------
Fax | 540-635-2732
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MICHAEL ALLEN PASTERNACK
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 540-635-1270
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 1035
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------