=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730635335
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY SPINAL ADJUSTING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2016
-----------------------------------------------------
Last Update Date | 09/01/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 E MARKET ST
-----------------------------------------------------
City | NAPPANEE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46550-2130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-773-3423
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 E. MARKET ST.
-----------------------------------------------------
City | NAPPANEE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46550-2130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-773-3423
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER/OWNER
-----------------------------------------------------
Name | DR. ANISSA GRUENDLER
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 574-773-3423
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 08001556
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------