=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407298946
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARDON FAMILY CHIROPRACTIC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2013
-----------------------------------------------------
Last Update Date | 07/25/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1472 N MUSTANG RD STE 102
-----------------------------------------------------
City | MUSTANG
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73064-7214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-256-6806
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1472 N MUSTANG RD STE 102
-----------------------------------------------------
City | MUSTANG
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73064-7214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-256-6806
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. AARON MICHAEL CARDON
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 405-256-6806
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | 4099
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------