=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366630725
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY CHIROPRACTIC PRACTICES, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2007
-----------------------------------------------------
Last Update Date | 11/06/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 239 S MAIN ST
-----------------------------------------------------
City | EDWARDSVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62025-1921
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-656-6565
-----------------------------------------------------
Fax | 618-656-6947
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 239 S MAIN ST
-----------------------------------------------------
City | EDWARDSVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62025-1921
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-656-6565
-----------------------------------------------------
Fax | 618-656-6947
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. CURTIS R BAIRD
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 618-656-6565
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 038-004680
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------