=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427125111
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEST IMAGE CHIROPRACTIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2006
-----------------------------------------------------
Last Update Date | 08/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 815 N PINE HILLS RD B
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32808-7234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-294-2007
-----------------------------------------------------
Fax | 407-294-2263
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 815 N PINE HILLS RD B
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32808-7234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-294-2007
-----------------------------------------------------
Fax | 407-294-2263
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINIC DIRECTOR
-----------------------------------------------------
Name | DR. AGAEZI O IKWUGWALU
-----------------------------------------------------
Credential | D.C
-----------------------------------------------------
Telephone | 407-294-2007
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | HCC6876
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------