=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376931576
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FALARDEAU FAMILY CHIROPRACTIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/23/2014
-----------------------------------------------------
Last Update Date | 12/23/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 383 E DUNSTABLE RD UNIT B
-----------------------------------------------------
City | NASHUA
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03062-4216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-864-0909
-----------------------------------------------------
Fax | 603-864-0907
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 383 E DUNSTABLE RD UNIT B
-----------------------------------------------------
City | NASHUA
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03062-4216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-864-0909
-----------------------------------------------------
Fax | 603-864-0907
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MARY FALARDEAU
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 603-864-0909
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 948
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------