=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700915659
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CASON CHIROPRACTIC CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2007
-----------------------------------------------------
Last Update Date | 12/22/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7476 WATERSIDE LOOP RD
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28037-7679
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-820-0147
-----------------------------------------------------
Fax | 704-820-0629
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7476 WATERSIDE LOOP RD
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28037-7679
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-820-0147
-----------------------------------------------------
Fax | 704-820-0629
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. DAVID BLAKE CASON
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 704-820-0147
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 3504
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------