=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861766313
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FOUGHTY CHIROPRACTIC CLINIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2012
-----------------------------------------------------
Last Update Date | 03/01/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6822 WHIPPLE AVE NW
-----------------------------------------------------
City | NORTH CANTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44720-7336
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-499-0147
-----------------------------------------------------
Fax | 330-499-8148
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6822 WHIPPLE AVE NW
-----------------------------------------------------
City | NORTH CANTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44720-7336
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-499-0147
-----------------------------------------------------
Fax | 330-499-8148
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JACK B FOUGHTY
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 330-499-0147
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 850
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------