=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649426784
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOOD HEALTH CHIROPRACTIC & ACUPUNCTURE LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2008
-----------------------------------------------------
Last Update Date | 09/30/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11124 E 28TH ST N SUITE 110
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67226-4562
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-613-2004
-----------------------------------------------------
Fax | 316-613-2004
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11124 E 28TH ST N SUITE 110
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67226-4562
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-613-2004
-----------------------------------------------------
Fax | 316-613-2004
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. WILLIAM EVERETT GOOD
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 316-613-2004
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 01-05210
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------