=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801476379
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAYVIEW OPTIMAL PERFORMANCE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2021
-----------------------------------------------------
Last Update Date | 04/09/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7 S BAYVIEW ST
-----------------------------------------------------
City | FAIRHOPE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36532-3401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-533-7255
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7 S BAYVIEW ST
-----------------------------------------------------
City | FAIRHOPE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36532-3401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-533-7255
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. SPENCER CALLAHAN
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 251-533-7255
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------