=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659819415
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BELCHER FAMILY CHIROPRACTIC LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2017
-----------------------------------------------------
Last Update Date | 02/01/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 ALMA DR 137
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75075-8844
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-423-5008
-----------------------------------------------------
Fax | 972-312-0397
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 700 ALMA DR 137
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75075-8844
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-423-5008
-----------------------------------------------------
Fax | 972-312-0397
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CHIROPRACTOR
-----------------------------------------------------
Name | DR. BROCK BELCHER
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 972-423-5008
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 13274
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------