=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508342494
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OUR FAMILY CHIROPRACTOR. PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2018
-----------------------------------------------------
Last Update Date | 11/12/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1108 N GREENVILLE AVE STE 115
-----------------------------------------------------
City | ALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75002-1948
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-204-6810
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1108 N GREENVILLE AVE STE 115
-----------------------------------------------------
City | ALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75002-1948
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-204-6810
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | ZHI LIN
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 646-204-6810
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 13698
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------