=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669859781
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAMS CHIROPRACTIC INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2015
-----------------------------------------------------
Last Update Date | 06/10/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5151 MURPHY CANYON RD STE 200
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92123-4440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-569-6959
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5151 MURPHY CANYON RD STE 200
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92123-4339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-569-6959
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. BARON TYLER SAMS
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 858-569-6959
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC33216
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------