=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649536848
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BIG KIDZ LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2012
-----------------------------------------------------
Last Update Date | 04/02/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10155 E VIA LINDA STE H136
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85258-5329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-553-8993
-----------------------------------------------------
Fax | 480-767-1845
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10155 E VIA LINDA STE H136
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85258-5329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-553-8993
-----------------------------------------------------
Fax | 480-767-1845
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. SIDNEY ASHCRAFT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 208-390-7056
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175F00000X
-----------------------------------------------------
Taxonomy Name | Naturopath
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------