=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497400667
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AXION TRAINER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2022
-----------------------------------------------------
Last Update Date | 02/16/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7035 BERACASA WAY STE 104
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33433-3454
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-361-4888
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5501 NW 2ND AVE APT 209
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33487-3855
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-368-0076
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ABBEY JO SHULKIN
-----------------------------------------------------
Credential | L.AC.
-----------------------------------------------------
Telephone | 786-368-0076
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------