=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639363245
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | POLAND FAMILY CHIROPRACTIC, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2007
-----------------------------------------------------
Last Update Date | 08/28/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8270 YOUNGSTOWN PITTSBURGH RD
-----------------------------------------------------
City | POLAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44514-2809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-757-8077
-----------------------------------------------------
Fax | 330-757-7487
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8270 YOUNGSTOWN PITTSBURGH RD
-----------------------------------------------------
City | POLAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44514-2809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-757-8077
-----------------------------------------------------
Fax | 330-757-7487
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | THOMAS PAUL SZALAY
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 330-757-8077
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2669
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------