=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801185707
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAPE FEAR VALLEY CHIROPRACTIC GROUP, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2011
-----------------------------------------------------
Last Update Date | 03/31/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4624 PINE NEEDLE CT
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28314-2463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-476-2225
-----------------------------------------------------
Fax | 206-426-6337
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4624 PINE NEEDLE CT 4624 PINE NEEDLE CT.
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28314-2463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-476-2225
-----------------------------------------------------
Fax | 206-426-6337
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. BAXTER W PASCHAL
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 910-476-2225
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 800
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------