=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508947060
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARE FULL CHIROPRACTIC INCORPORATED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2006
-----------------------------------------------------
Last Update Date | 04/05/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1819 BRACKETT AVE
-----------------------------------------------------
City | EAU CLAIRE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54701-4628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-514-1450
-----------------------------------------------------
Fax | 715-514-1448
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1819 BRACKETT AVE
-----------------------------------------------------
City | EAU CLAIRE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54701-4628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-514-1450
-----------------------------------------------------
Fax | 715-514-1448
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JON STEVEN SHIMODA
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 715-514-1450
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2898
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------