=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447724042
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WELSH CHIROPRACTIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2019
-----------------------------------------------------
Last Update Date | 01/16/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8885 RIO SAN DIEGO DR STE 357
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92108-1652
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-293-3453
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8885 RIO SAN DIEGO DR STE 357
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92108-1652
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-293-3453
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. JARRET WELSH
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 619-293-3453
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NS0005X
-----------------------------------------------------
Taxonomy Name | Sports Physician Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------