=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588969729
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALIGN CHIROPRACTIC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2011
-----------------------------------------------------
Last Update Date | 01/05/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15278 W BELL RD STE 114
-----------------------------------------------------
City | SURPRISE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85374-3101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-229-6193
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15278 W BELL RD STE 114
-----------------------------------------------------
City | SURPRISE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85374-3101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-229-6193
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | JASON HAWKINS
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 623-229-6193
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 8041
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------