=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851797021
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | APPLIED HEALTH CHIROPRACTIC CLINIC, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2014
-----------------------------------------------------
Last Update Date | 11/14/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3302 PENCOMBE PL
-----------------------------------------------------
City | FLINT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48503-2351
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-513-1703
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3302 PENCOMBE PL
-----------------------------------------------------
City | FLINT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48503-2351
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-513-1703
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JASON J SEFA
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 810-513-1703
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2301008411
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------