=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790077147
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEST SOUND CHIROPRACTIC, P.S.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2011
-----------------------------------------------------
Last Update Date | 05/04/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1008 BETHEL AVE STE A
-----------------------------------------------------
City | PORT ORCHARD
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98366-4236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-895-7744
-----------------------------------------------------
Fax | 360-895-1166
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1008 BETHEL AVE STE A
-----------------------------------------------------
City | PORT ORCHARD
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98366-4236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-895-7744
-----------------------------------------------------
Fax | 360-895-1166
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CHIROPRACTOR
-----------------------------------------------------
Name | DR. JAMES P FARRELL
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 360-895-7744
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH00034029
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------