=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366032070
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW WAVE CHIROPRACTIC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2021
-----------------------------------------------------
Last Update Date | 04/19/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 52 PALCICH RD
-----------------------------------------------------
City | FRANKFORT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49635-9602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-421-8082
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12702 KING RD
-----------------------------------------------------
City | THOMPSONVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49683-9344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 124-842-1808
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR OF CHIROPRACTIC
-----------------------------------------------------
Name | DR. MEGAN TAYLOR ZARNICK
-----------------------------------------------------
Credential | D.C
-----------------------------------------------------
Telephone | 124-842-1808
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------