=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497944391
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MY FAMILY CHIROPRACTOR, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2007
-----------------------------------------------------
Last Update Date | 10/17/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 COMMERCE CT
-----------------------------------------------------
City | GLADWIN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48624-1220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-426-6121
-----------------------------------------------------
Fax | 989-426-5466
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 120 COMMERCE CT
-----------------------------------------------------
City | GLADWIN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48624-1220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-426-6121
-----------------------------------------------------
Fax | 989-426-5466
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ALBERT PETER SAWAYA
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 989-426-6121
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NS0005X
-----------------------------------------------------
Taxonomy Name | Sports Physician Chiropractor
-----------------------------------------------------
License Number | AS005236
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------