=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497222780
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CODDINGTON RX BODYWORKS CHIROPRACTIC CORP.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2018
-----------------------------------------------------
Last Update Date | 10/25/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 28720 ROADSIDE DR STE 335
-----------------------------------------------------
City | AGOURA HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91301-3464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-989-3903
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28720 ROADSIDE DR STE 335
-----------------------------------------------------
City | AGOURA HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91301-3464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-989-3909
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRES
-----------------------------------------------------
Name | DR. AMANDA CODDINGTON
-----------------------------------------------------
Credential | DC, L.AC
-----------------------------------------------------
Telephone | 714-989-3903
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------