=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366775264
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BABCOCK CHIROPRACTIC & WELLNESS CENTER INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2009
-----------------------------------------------------
Last Update Date | 12/17/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8620 E 32ND CT N
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67226-4007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-612-0600
-----------------------------------------------------
Fax | 316-612-1140
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8620 E 32ND CT N
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67226-4007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-612-0600
-----------------------------------------------------
Fax | 316-612-1140
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. ARMANDO ROMAN BABCOCK I
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 316-612-0600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 01-05234
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------