=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811924152
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOEL R. KLEVEN, D.C., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 113 E PARK AVE SUITE # 101
-----------------------------------------------------
City | WEATHERFORD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76086-5600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-594-0281
-----------------------------------------------------
Fax | 817-598-1150
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 113 E PARK AVE SUITE # 101
-----------------------------------------------------
City | WEATHERFORD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76086-5600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-594-0281
-----------------------------------------------------
Fax | 817-598-1150
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JOEL RAE KLEVEN
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 817-594-0281
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2933
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------