=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467766568
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRIS E. CEMBALISTY D.C., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2010
-----------------------------------------------------
Last Update Date | 07/30/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1036 N 4TH ST
-----------------------------------------------------
City | GRAND JUNCTION
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81501-7560
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-256-7604
-----------------------------------------------------
Fax | 970-256-0244
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1036 N 4TH ST
-----------------------------------------------------
City | GRAND JUNCTION
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81501-7560
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-256-7604
-----------------------------------------------------
Fax | 970-256-0244
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | CHRIS E CEMBALISTY
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 970-256-7604
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 4309
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------