=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598108094
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BATESVILLE CHIROPRACTIC WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2013
-----------------------------------------------------
Last Update Date | 05/06/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2511 HARRISON STREET
-----------------------------------------------------
City | BATESVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-569-4954
-----------------------------------------------------
Fax | 855-593-5963
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2511 HARRISON STREET
-----------------------------------------------------
City | BATESVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-569-4954
-----------------------------------------------------
Fax | 855-593-5963
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PROVIDER
-----------------------------------------------------
Name | MR. MORGAN THOMAS SENSABAUGH
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 870-569-4954
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 16020
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------