=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679757694
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DOUGLASS FAMILY CHIRPRACTIC, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/27/2007
-----------------------------------------------------
Last Update Date | 12/27/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 226 S. FORREST ST
-----------------------------------------------------
City | DOUGLASS
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-746-2201
-----------------------------------------------------
Fax | 316-746-2245
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 382
-----------------------------------------------------
City | DOUGLASS
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67039-0382
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-746-2201
-----------------------------------------------------
Fax | 316-746-2245
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT / SECRETARY / DOCTOR
-----------------------------------------------------
Name | JEFFREY STEVEN HOWELL
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 316-746-2201
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 7758
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 01-05140
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------