=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821327859
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRAUN CHIROPRACTIC LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2009
-----------------------------------------------------
Last Update Date | 12/22/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1821 N MASTICK WAY STE #1
-----------------------------------------------------
City | NOGALES
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85621-1031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-281-1300
-----------------------------------------------------
Fax | 520-281-4185
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1821 N MASTICK WAY STE #1
-----------------------------------------------------
City | NOGALES
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85621-1031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-281-1300
-----------------------------------------------------
Fax | 520-281-4185
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | YVETTE D BRAUN
-----------------------------------------------------
Credential | D.C
-----------------------------------------------------
Telephone | 520-281-1300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC5083
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------