=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578721635
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BENTLEYVILLE CHIROPRACTIC CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2008
-----------------------------------------------------
Last Update Date | 05/27/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 104 JOHNSTON RD
-----------------------------------------------------
City | BENTLEYVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15314-1104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-239-2225
-----------------------------------------------------
Fax | 724-239-2250
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 104 JOHNSTON RD P.O. BOX 194
-----------------------------------------------------
City | BENTLEYVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15314-1104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-239-2225
-----------------------------------------------------
Fax | 724-239-2250
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. BRIAN SCOTT HASCHETS
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 724-239-2225
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | PA005528L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------