=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467987693
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARIE CAFASSO ROYER CHIROPRACTIC CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2017
-----------------------------------------------------
Last Update Date | 04/25/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 740 FRONT ST SUITE 130
-----------------------------------------------------
City | SANTA CRUZ
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95060-4535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-465-9088
-----------------------------------------------------
Fax | 831-465-8528
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 740 FRONT ST SUITE 130
-----------------------------------------------------
City | SANTA CRUZ
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95060-4535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-465-9088
-----------------------------------------------------
Fax | 831-465-8528
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MARIE CAFASSO ROYER
-----------------------------------------------------
Credential | D.O
-----------------------------------------------------
Telephone | 831-465-9088
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 24304
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------