=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508970336
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A-SUN NATURAL HEALTH CENTER, LTD.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2006
-----------------------------------------------------
Last Update Date | 03/16/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1911 N AUSTIN AVE STE 405
-----------------------------------------------------
City | GEORGETOWN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78626-4543
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-869-9811
-----------------------------------------------------
Fax | 512-366-9902
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4219 WILLIAMS DR
-----------------------------------------------------
City | GEORGETOWN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78628-1337
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-863-2786
-----------------------------------------------------
Fax | 512-366-9902
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRES/TREAS./PROVIDER
-----------------------------------------------------
Name | DAVID W. LOPER
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 512-869-9811
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 5101
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------