=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760523682
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LACOMBE CHIROPRACTIC & WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2007
-----------------------------------------------------
Last Update Date | 08/27/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6024 S STATE ROUTE 48
-----------------------------------------------------
City | MAINEVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45039-8280
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-494-0694
-----------------------------------------------------
Fax | 513-494-0695
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6024 S STATE ROUTE 48
-----------------------------------------------------
City | MAINEVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45039-8280
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-494-0694
-----------------------------------------------------
Fax | 513-494-0695
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DAVID JOSEPH BERRING
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 503-503-3796
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 3213
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------