=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568648814
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BIRK CHIROPRACTIC, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2008
-----------------------------------------------------
Last Update Date | 11/19/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3701 FAIRWAY BLVD SUITE 116
-----------------------------------------------------
City | WICHITA FALLS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76310-1036
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-692-2600
-----------------------------------------------------
Fax | 940-692-5398
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3701 FAIRWAY BLVD SUITE 116
-----------------------------------------------------
City | WICHITA FALLS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76310-1036
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-692-2600
-----------------------------------------------------
Fax | 940-692-5398
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ROBERT LEE BIRK
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 940-692-2600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 7261
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------