=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568760221
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BACKCARE CHIROPRACTIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2011
-----------------------------------------------------
Last Update Date | 03/04/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 43 NORTHWOOD DR
-----------------------------------------------------
City | DELAWARE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43015-1501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-369-4806
-----------------------------------------------------
Fax | 740-369-4902
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 332
-----------------------------------------------------
City | DELAWARE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43015-0332
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-369-4806
-----------------------------------------------------
Fax | 740-369-4902
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROPRIETOR/OWNER
-----------------------------------------------------
Name | DR. STEVEN EDWARD HENDERSON
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 740-369-4806
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 1052
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------