=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619109915
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DISCOVER HEALTH CHIROPRACTIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2009
-----------------------------------------------------
Last Update Date | 08/20/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2855 MILLER DR STE 101
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46563-8091
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-941-1086
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 34
-----------------------------------------------------
City | LAPAZ
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46537-0034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-941-1086
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ANGELA M HUMMEL
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 574-941-1086
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 08002274A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------