=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457691768
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARA JANET MAYS DC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2013
-----------------------------------------------------
Last Update Date | 02/21/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3014 PLEASANT VALLEY BLVD # 2
-----------------------------------------------------
City | ALTOONA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16602-4491
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-944-8483
-----------------------------------------------------
Fax | 814-944-5375
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3014 PLEASANT VALLEY BLVD # 2
-----------------------------------------------------
City | ALTOONA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16602-4491
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-944-8483
-----------------------------------------------------
Fax | 814-944-5375
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 5124
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC010704
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------