=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598076077
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RESTORATION CHIROPRACTIC: SPINAL CORRECTION & FAMILY HEALTH CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2010
-----------------------------------------------------
Last Update Date | 06/29/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 503 MAIN ST
-----------------------------------------------------
City | BELTON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64012-2513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-425-5578
-----------------------------------------------------
Fax | 816-425-5579
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 503 MAIN ST
-----------------------------------------------------
City | BELTON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64012-2513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-425-5578
-----------------------------------------------------
Fax | 816-425-5579
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR OF CHIROPRACTIC
-----------------------------------------------------
Name | DR. NICHOLAS B WEDDLE
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 816-425-5578
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2010001488
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------